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: Jj 5r PL.R.1 V(„)j-..L - COL
applicable)
P.O. /Project Number: fUe■Jj
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WET: Acute (Indicate Below) 1
WET: Chronic (Indicate Below)
WET: Accelerated (Indicate Below)
WET: PTI /TIE /TRE (Indicate Below)
Metals (List Below)
Solids (TS /TDS /TSS) (Circle)
Anions (List Below)
Chromium III /VI (Circle)
aseaa0 pue Il0
Coliform (Total /Fecal /E -Coli) (Circle)
BOD /COD (Circle)
Other Analysis (List Below)
Number of Containers
Total Volume
Contact: (. -(7
n '
Address: 2.7(.41., kki ,5` Ave. N Av UUI °', Cc> 4 iltoi
Phone # `140 %6 f 1 f 9b
E -Mail: t R iIo:FC,00tt.1i•,.r,40
Fax # ° f 7() g(.4 Zit c
Sampler: T — t = iny
Report By: IN Mail -PD -- 0 FAX
Sample Location or ID
Date
Time
Grab/
Com •
Lab ID
LAa use Only)
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7 .7 7 . f 2 . 2.
lc 40
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1.-..-
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Turnaround Requirements
(Analytical Testing Only!
Test Species: athead Minnow,12t ❑Daphnia magna ®Daphnia pulex ❑Other (List Below}
Standard (10
days)
6 Day
1 -2 Day
Special Instructions /Comments:
3 -5 Day
Requested Report Date:
Relinquished By (1)
- Received By (1)
Relinquished By'(2)
Received By (2) ' '
Signature
Date/Time
Si r
Date/Time
7/? ' /
Signature
Date/Time
Signature
Date /Time
SeaCrestGrou
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CHAIN OF CUSTODY
1341 Cannon Street Louisville, CO 80027
[phone] - FAX [phone]