2012-09-19_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 9/19/2012
• Doc Name: SURFACE WATER DATA FOR JULY 2012
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No.5128 0900 1882
Project Name: Schwartz -
DATE: 7112/12 SSTF: S26517
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1750
Contact Name: Crank Adamic
Voice: 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
Anne Ary
1 3 ext. 209
Fax: 669
Purchase Order #:
ELI Quote #:
Report Required For: POTWNVWTP
Other
Number of Containers
Sample Type:
—t AWSVBO
&ir, Water &Ils/So ids, Ye9etatan,
}s fiioassay Other
ANAL" SAS REQUESTE
Normal Turnaround (TAT)
Notify ELI prior t
RUSH sample
submittal for
F additional charges
t and scheduling
Recei9ptrTem
jj��
U - dissolved only - CODE #1
U - total & dissolved - CODE tle3
Ra -226 total & dissolved CODE#F3
4 Algel
Cooler ID(s)
�1 � r
Custodyyal
Y 'v
Intact
Y
Signatu
Y N
Match ID
Y
Special Report
prior to sample
NELAC ❑
Other
EDD/EDT ■
Formats — ELI must be no
submittal for the following
A2LA ■ Level IV
Format
RUSH Turnaround
Comments:
SUA Schedule Code :
SW CODE I 1
Table 1
Frequency 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
•
❑
❑
❑
❑
■
.
❑
❑
■
❑
•
),-.
2 SW -BPS
7/12/12
10:00
r Water 1
®
❑
•
0
❑
❑
❑
❑
•
❑
®
•
Code 1
� Z
3
❑
❑
•
❑
❑
•
❑
•
•
•
❑
•
LIJ
4
.
❑
❑
•
❑
❑
•
❑
❑
❑
❑
❑
5
❑
❑
❑
❑
❑
❑
•
❑
❑
•
❑
❑
›-
8
❑
❑
•
•
❑
•
❑
•
❑
❑
❑
❑
rII—
Ce
7
❑
❑
❑
•
•
❑
❑
•
❑
❑
•
■
8
•
0
0
0
0
•
0
0
0
U
❑
•
en
❑
❑
•
•
❑
•
❑
❑
•
•
❑
❑
7c1.61 .
10
•
❑
■
❑
❑
❑
❑
❑
•
❑
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:7 /12/12 16:30
___,
Shipped by: FedEx
Shipped by:
Received by: DaterTime: 7- .4,1
Relinquished by: Date/Time:
Received by: Date/Time:
Sample Disposal: Return to Client ❑ Lab Disposal ®
LABORATORY USE ONLY
Sample Type # of fractions
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