2012-10-05_HYDROLOGY - C1981008

• Permit No: C1981008
• IBM Index Class Name: Hydrology
• Doc Date: 10/5/2012
• Doc Name: WET Testing - No Pattern of Toxicity Outfall 013 ‎(CO-0000213)‎
• From: Western Fuels Colorado
• To: WQCD
• Email Name: MLT
• Email Name: SB1
• Media Type: D
• Archive: No

Client /Project Name: \ ecat r �" J1 -LS Cot-La-kW
applicable)
P.O. /Project Number: /JQVJ 1A M z"•1.
WET: Acute (Indicate Below)
WET: Chronic (Indicate Below) 1
WET: Accelerated (Indicate Below)?
WET: PTI /TIE /TRE (Indicate Below)
Metals (List Below)
i Sol ids (TS /TDS /TSS) (Circle)
Anions (List Below)
Chromium III /VI (Circle)
iOil and Grease
Coliform (Total /Fecal /E -Coli) (Circle)
BOD /COD (Circle)
Other Analysis (List Below)
Number of Containers
Total Volume
Contact: O � -
Address: 274 4C. w 0 ue j.— C g t
Phone# 97 .g0.79 4U
E- Mail: rre.
Sampler: - 1 - 1 7 (1.1
Fax eti°46 f — L$
Report By: C] Mail
1F FAX
Sample Location or ID
Date
Time
Grab/
Comp
Lab ID
(LABUSeOIVM
L
oval
Turnaround Requirements
(Analytical TestingOniv{
Test Species: ❑ Fathead Minnow EaKriodaphnia ❑ Daphnia magna ❑ Daphnia pulex
Other (List Below)
•
Standard (10
days)
6-9 Day
1 -2 Day
Special Instructions /Comments:
3 -5 Day
Requested Report Date:
Relinquished By (1)
Received By
Relinquished By (2)
Received By (2)
Signatur •
ate
Date /Ti ,e�
�' - 0
Signature
Date/Time
Signature
Date /Time
Signature r ,, A /
�7 �T / 1
Date /Time
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CHAIN OF CUSTODY
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