2012-08-06_HYDROLOGY - M1977300 ‎(3)‎

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

Company Name: Cotter Corporation
Tracking N0.5128 0900 1941
Project Name: Schwartz -
DATE: 5/15/12 SSTF: S26387— S26388
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1'
Contact Name: Frank Adamic
vim: 1- 719- 275 -7413 ext. 204
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
413 ext. 209
Fax: 1669
Purchase Order #:
ELI Quote #:
A
Report Required For. POTWM
Other
Number of Containers
Snle TYPe'
AWSVBO
elic X �. yegemuon.
ANAL Fi :OUESTED
(1Vl) Pmrouswnl IetwoN
Notify ELI prior to
RUSH sample
submittal for
p additional charges
. and scheduling
R�Q� Temp
o C
itt moo - A1U WAl - n
ae WOO - WPM) p le101 - n
MOOD PeAlossIP V IBM 9iZ - 821
SEE ATTACHED TABLE 1
Cner ID( ,
- - T '
� ° "'`
Special Report Formats — ELI must be r
prior to sample submittal for the following:
NELAC ❑ A2LA ❑ Level IV 0
Other
EDD/EDT ❑ Format
b eal
Custo¥d�
intact
Y/N
Signature
Y / N
Match LAB ID
Y/N
punoununl HSn2!
Comments:
S&A Schedule Code :
SW cope I1
Table 1
Frequency 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
me
1 SW AWD
5/15/12
13:35
Water 1
c i
❑
❑
❑
❑
❑
❑
❑
❑
❑�_0
Codes
j
2 SW
5/15/12
16:25
W a t e r 1
®
❑
•
❑
•
❑
❑
❑
• ❑
®
❑
Code 1
Z
0
3
•
❑
❑
❑
❑
❑
•
❑
❑ ❑
�_..
❑
❑
W
4
0
0
0
0
0
0
0
0
0 0
0
E 1
s
5
❑
❑
❑
•
❑
❑
❑
❑
❑ ❑
❑
❑❑
›."
a
❑
❑
❑
•
❑
❑
❑
❑
❑ ❑
❑
❑
7
0
0
0
0
0
0
0
n
• 0
•
•
Ci5 - loq(
IZ �
co
8
❑
❑
❑
❑
❑
❑
❑
❑
❑ ❑
❑
•
8
❑
❑
❑
•
❑
❑
❑
•
❑ •
❑
❑
10
❑
❑
❑
❑
❑
•
❑
❑
❑ ❑
❑
❑
Custody
Record
MUST be
Signed
Relinquished b Bole Tennant_Date/Time:5116/1216:30
Shipped by: FedEx
Received by Date/Time:
R by Date/Time:
Shipped by:
Received by 714 DateJTime: y -t
Sample Disposal: Retum to Client • Lab Disposal two
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. Pagel of