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 1816
Project Name: Schwartz -
DATE: 6/20/12 SSTF: S26506 & S26507
Report Mail Address:
Cotter Corporation - Carton 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
Tel: [phone] ext. 209
Fax: -1669
Purchase Order #:
ELI Quote #:
Report Required For POTWNVVVTP
Other
M
C Number of Containers
y Sample Type:
—I AWSVBO
73 6p, Water $o Is/SoI ds, Yegetatan,
X Bioassay Qther
Aria. r b IS rrs= a ¢-at
Normal Tumaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
a additional charges
t✓ and scheduling
R ipt Temp
iO C
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra -226 total & dissolved CODE#3
i. eIQEJ.
Coqi
Ci ),
Special Report Formats — ELI must be
prior to sample submittal for the following:
NELAC ❑ A2LA ■ Level
Other
EDD /EDT ❑ Format
Custody a1
Y / (�� j
Intact
Y / i
Signature
Y /
Match ID
Y /
RUSH Turnaround
Comments:
S&A Schedule Code :
SW CODE I 1
Table 1
Frequency 1
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW AWD
6/20112
16:10
Water 1
®
■
❑
❑
■
■
■
❑
❑
❑
®
•
Code 1
..
2 SW - BPL
6/20112
14:25
Water 1
_<
❑
❑
❑
❑
•
❑
•
❑
❑
0 .
0
❑
•
Code 1
1
=
;
rk
3
•
0
0
0
0
0
•
•
O
•
4
•
•
•
❑
❑
❑
❑
•
•
❑
❑
•
5
0
0
•
•
• •
❑
■
•
■
■
■
,
6
■
■
❑
❑
■
■
.
❑
■
■
■
❑
0
r--
7
•
❑
❑
❑
❑
❑
❑
❑
❑
❑
•
❑
c- laotou
8
❑
❑
•
❑
❑
❑
❑
❑
❑
❑
❑
❑
CO
8
❑
❑
■
■
■
❑
•
❑
❑
❑
❑
❑
10
0
0
•
0 0
•
0
0
•
0
•
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:6/21 /12 16:30
Shipped by: FedEx -.N c-
Shipped by:
Received by
i terfime:O ig'y
Relinquished by: Date/Time:
Received by: Date/Time:
Sample Disposal: Return to Client ❑ Lab Disposal CI
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