2012-08-06_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 8/6/2012
• Doc Name: SURFACE WATER DATA FOR APRIL 2012
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No.3692013 61634495 & 71
Project Name: Schwartz -
DATE: 4/05/12 SSTF: S26451-- S26458
Report Mad Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -17
Contact Name: Randy Whicker
Voice: • '19- 275 -7413 ext. 210
Sampler Name if other than Contact
1- 303 - 642-3893 mine phone
Bob Tennant 1 -719- 371 - 3009 -cell
Invoice Address:
PO Box 1750
Canon City, CO 81215 -1750
Anne Ary
13 ext. 209
Fax: 669
Purchase Order #:
ELI Quote #:
_.g C
Report Required For. POTW/WI
Other
Number of Containers
Semple Type:
AWSVBO
Air, 1p(ater $oNsWSoiids, yegetat on,
X @ioassay Other
a tiA,_•r 5 s 3 REQUESTED
Normal Tumaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
i a dditional charges
t and scheduling
Receipt Temp
3 ° C
U - dissolved only - CODE #1
CO 3000 - Pe P's Isloi - fl
Ra-226 total & dissolved CODE#3
SEE ATTACHED TABLE 1
Coo ID(s)
Special Report Formats — ELI must be notified
prior to sample submittal for the following
NELAC ❑ A2LA ❑ Level IV
Other
EDO/EDT 0 Format
Custody Y / al
Intact
Y I N
Signature
Y / N
Match LAB ID
Y / N
RUSH Turnaround
Comments:
S&A Schedule Code :
SW CODE II 1
Table 1
F 1,
Twwo o c co oollee rs
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW AWD
4/05112
10:05
Water 7
❑
1
•
CO
❑
•
0
•
•
❑
0
❑
Table 1
--
2 SW AO01
4/05/12
8:00
Water 1
0
•
•
•
❑
•
•
•
0
• ■
0
❑
Code 1
3 SW BDIS
4105/12
8:20
Water 1
0
0
❑
0
❑
•
0
•
•
0
-
1
Code 1
Ili
4 SW PL
4105/12
8:25
Water 1
®
•
•
❑
•
•
0
❑
•
•
0
Code 1
5 SW OS
4/05/12
8:35
Water 1
®
.
0
•
•
❑
•
•
D
❑
.
Code 1
Cia
6 SW BOS
4/05/12
9:25
Water 1
0
❑
❑
❑
D
0
•
❑
❑
❑
0
0
Code 1
`l�01031
7 SW GS
4/05/12
9:35
Water 1
0
0
•
❑
D
•
❑
0
❑
•
®
❑
Code 1
Cc
a SW BPL
4/05/12
10 :35
Water 7
0
•
•
t:
❑
❑
•
•
❑
❑
0
' 0
Table 1
cc
s
•
❑
❑
.
❑
❑
•
❑
•
0
•
■
---
10
❑
•
•
•
❑
❑
0
•
❑
•
.
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:4/05/12 16:30
Shipped by: FedEx
Shipped by:
Received by: Date/Time:
Relinquished by Date/Time:
Received by X`1 s � Date/Time: '/ .1; /oi?e
Sample Disposal: Return to Client • Lab Disposal e
LABORATORY USE ONLY
Sample Type # of fractions
Chain of Custody and Analytical Request Record
PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 1 of 1