2012-12-12_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/12/2012
• Doc Name: Surface Water Data for October 2012.
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No 3692013 61651058
Project Name: Schwartz -
DATE: 10/17/12 SSTF: S26574
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -175
Contact Name: Frank Adamic
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
Invoice Contact JoAnne Ary
3 ext. 209
Fax: 69
Purchase Order #:
ELI Quote #:
Report Required For. POTWAN
Other
Number or Containers
Sample Type:
g Air Water fiolleroolids, AWSVBO
X Bioassay Oiler Vegetation,
ANALYSIS REOU STE'
,
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
p additional charges
. and scheduling
R pt Temp
C
C ler ID
U - dissolved only - CODE #1
£# 3aoo - peAlosimp'8 Ielo) - n
Ra-226 total & dissolved CODE$3
i epsl
Special Report
prior to sample
NELAC •
Other
EDD /EDT
Formats - ELI must be notified
submittal for the following:
A2LA ■ Level IV
❑ Format
•
Custody
Y 6,./
Intact
Y
Signafure
Y?Sr
Match L AB
Y
RUSH Turnaround
Comments:
S&A Schedule Code :
SW CODE 11
Table 1
Frequency 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1
0
0
0
•
*
0
0
0
❑
•
❑
❑
2 SW-BPL
10/17/12
8:00
Water 1
0
0
❑
❑
❑
❑
❑
•
❑
❑
-i
❑
.>`.a
Z
3
•
•
❑
❑
❑
❑
•
.
❑
❑
_...�
❑
•
w
4
❑
❑
❑
❑
❑
❑
❑
•
•
•
0
0
`
5
0
0
0
•
0
0
•
•
0
0
0 ❑
6
•
•
0
0
0
•
0
❑
©
0
II— ,. ..,v
7
❑
•
❑
•
❑
❑
❑
❑
•
❑
❑
•
8
•
•
©
❑
a
•
❑
•
❑
❑
•
■
m
9
❑
•
❑
❑
❑
❑
•
❑
❑
❑
•
•
_I
10
❑
•
❑
❑
•
❑
❑
0
❑
❑
❑
.
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:10/17 /12 16 30
Shipped by: FedEx
Shipped by:
Received by Date/Time:
Relinquished by: Date/Time:
A/ 4i 1=-
Received b . lit, Date/Time: mile;
Sample Disposal: Return to Client ❑ Lab Disposal ►:�
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