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

i `N
SW ARH
SW LLHG
Custody
Record
MUST be
Signed
7/19/12 • 11 :30 Water 3 ❑
7/19/12 11:10 Water 3 ❑
0
0
Relinquished by:
Relinquished by: Bob Tennant Date/Time:7 /19/12 16 30
Date/Time:
re
❑ ❑ D ❑ ❑ D ❑ ❑ D
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® ® ❑ ❑ ❑ ❑ D D ❑
D ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑ D ❑ ❑ D
O 0 0 0 0 0 0 0 0
O 0 0 0 0 0 0 0 0
❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
❑ ❑ D ❑ ❑ ❑ r0 ❑ 0
❑ O ❑ ❑ ❑ ❑ O D 0
Sh'pped by: FedEx
Sh'pped by:
Notify ELI prior to
RUSH sample
submittal for
P additional charges
. and schedulin
Received b
• ate/Time: . 2...
RY USE ONLY
# of fractions
Company Name: Cotter Corporation
Tracking No.3692013 61650877
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1750
Invoice Address:
PO Box 1750
Canon City, CO 81215 -1750
Report Required For.
Other
Special.Report Formats
Prior to sample submittal
NELAC j] A2LA 0
Other
EDD /EDT ❑ Format
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Sample 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
POTW/ WVTP ❑
— ELI must be notified
for the following:
Level IV
Collection Collection
Date Time
Project Name: Schwartz -
DATE:7 /19/12 SSTF: S26537 & S26538
Contact Name: frank Adamic
Voice: 1- 719 - 275 -7413 ext 204
Invoice Contact: JoAnne Ary
Tel: [phone] ext. 209
Fax: [phone]
MATRIX
Return to Client ❑
Lab Disposal El
Sampler Name if other than Contact:
1- 303 - 642 -3893 mine phone
Bob Tennant 1 -71 371 - 3009 -cell
Purchase Order #: ELI Quote #:
Received by: Date/Time:
P
ustody Seal
Y /A'
Intact
Y / N�
Signature
Y/N
Match LAB ID
Y/N