2012-09-04_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 9/4/2012
• Doc Name: SURFACE WATER DATA FOR 06/2012
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No.5128 0900 1805
Project Name: Schwartz -
DATE: 6/13/12 SSTF: S26497—S26498
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1
Contact Name: Frank Adamic
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
1669
Purchase Order #:
ELI Quote #:
Report Required For: PO1WNVVVTP 0
Other
Number of Containers
Sample Type:
—I AWSVBO
22 Air, Water,aoda/Solids, vegetation,
X Litoassay Qther
A#+ AL'dsL; nEcU._Si L:.›
Norma( Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
F additional charges
. and scheduling
Receipt Temp
a� e C
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra -226 total & dissolved CODE#3
1 e14s1
1
Cooler
D(s)
Special Report
prior to sample
NELAC •
Other
EDD /EDT
Formats - ELI must be notified
submittal for the following:
A2LA ❑ Level p
❑ Format
Custodal
Y
Intact
Y I N
Signature
Y / N
Match LAB ID
Y / N
RUSH Turnaround
Comments:
SBA Schedule Code :
SW CODE 11
Table 1
Frequency 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW AWD
6/13/12
14:05
Water 1
®
•
❑
•
❑
❑
•
•
❑
❑
0
0
Code 1
2 Sw - BPL
6/13/12
11:00
Water 1
ID
❑
•
•
•
❑
•
•
❑
•
=
■
Code 1
0
3
0
0
•
0
0 •
■
❑
■
•
t3.t
4
•
•
•
0
•
0
0
•
•
•
❑
❑
5
•
❑
❑
❑
❑
❑
❑
❑
❑
•
•
•
6
•
•
❑
■
❑
■
❑
❑
■
■
■
.
r--
7
❑
■
❑
f0
❑
■
❑
■
■
❑
❑
❑
cr-
g
•
0
0
0
•
0
0
•
•
0
0
m
9
❑
❑
❑
0
❑
•
❑
❑
•
•
0
10
❑
❑
•
0
❑
❑
■
.
❑
■
.
.
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant DateTme:6 /15/12 16:30
Shipped by FedEx
Shipped by:
Received by: Date/Time:
Relinquished by: Date/Time:
Received by: 77 Date/Time: 6- is-- i `7
LABORATORY USE ONLY
Sample Type # of fractions
Sample Disposal: Retum to Client ❑ Lab Disposal ®
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