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 61634488
Project Name: Schwartz -
DATE: 4/11/12 SSTF: $26436 & S26442 & S26443
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -17
Contact Name: Randy Whisker
Voice: 1- 719 -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
JoAnne Ary
13 ext. 209 -
Fax: 669
Purchase Order #
ELI Quote #:
Report Required For POTW/W
Other
Number of Containers
Semple Type:
AWSVBO
Air, IalSollds, Yepetatron.
X Oiler
ANALYSIS REQUESTED
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
a additional charges
. and scheduling
P
, C
U - dissolved only - CODE &1
U - total & dissolved - CODE #3
Ra -226 total & dissolved CODFalt3
SEE ATTACHED TABLE 1
�erI
Special Report
prior to sample
NELAC •
Other
EDD /EDT •
Formats — ELI must be n
submittal for the following:
A2LA 0 Level IV
Format
Custodyal
Y
Intact
Y / N
Signature
Y / N
Match LAB 1D
Y / N
RUSH Turnaround
Comments:
S&A Schedule Code :
SW CODE I 1
Table 1
Frequency/ 1,
Two coolers
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collodion
Date
Collection
Time
' SW AWD
4/11/12
12:15
Water 1
0
•
•
•
•
❑
❑
•
•
❑
0
❑
Code 1
�.-
❑
•
•
❑
❑
❑
❑
r
•
•
❑
❑
❑
•
❑
❑
•
❑
❑
❑
❑
❑
❑
0
❑
1LS
•
.
❑
❑
•
❑
■
•
❑
❑
•
❑
:,
❑
❑
•
❑
❑
❑
❑
❑
•
•
•
❑
>
■
❑
•
■
■
•
•
•
❑
•
•
❑
SW GS
4/05/12
14:45
Water 1
0
•
❑
•
❑
•
•
•
❑
0
.�
❑
Code 1
iszt
e SW BPL
4/05/12
14:00
Water 1
0
❑
❑
❑
❑
❑
0
•
❑
•
0
•
Code 1
ca
s
❑
•
•
❑
❑
•
❑
❑
•
❑
•
❑
ice
..,4
10
❑
❑
❑
•
•
❑
•
❑
❑
•
❑
•
Custody
Record
MUST be
Signed
Relinquished by Bob Tennant Date/Time:4/12/12 16:30
Shipped by. FedEx
Shi Pled by:
Received by(J DatefTme:14. i 3 . 1o!
Relinquished by: Date/Time:
Received by: Date/Time:
Sample Disposal: Retum to Client ❑ Lab Disposal 0
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