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 61651072
Project Name: Schwartz -
DATE: 10/18/12 SSTF: S26648 & S26649 & S26650
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -17
Contact Name: Frank Adamic
- 19- 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
3 ext. 209
Fax: 669
Purchase Order #:
ELI Quote #:
ANALYSIS REQUESTED
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample'
submittal for
P additional charges
tr, and scheduling
Race t Temp ft
C I
Report Required For. POTW/W
Other
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra -226 total & dissolved CODE#3
[SEE ATTACHED TABLE 1
Cog) ra
Special Report Formats - ELI must be notified
prior to sample submittal for the following
NELAC ❑ A2LA ❑ Level IV
Other
EDD /EDT ❑ Format
Number of Contains
Sample Type:
—� AWSVBO
7 Air, Water $oiisSolids, Yepe
X 61oassay Other
Custody Seal
Y / rt ,
Intact
Y /6)
Signature
Y /,l�
Match L4$ Y
RUSH Turnaround
Comments:
S&A Schedule Code
SW CODE 13
Table 1
(
Two coolers
Two
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
SW FBRG
10/18/12
10:10
Water 7
❑
•
•
®
❑
•
❑
❑
❑
❑
0
•
Table 1
2 SW ARH
10/18/12
11:25
Water 3
•
0
®
■
❑
❑
❑
❑
❑
❑
0
Code 3
- u.s
owl
=
3 SW LLHG
10/18/12
11:40
Water 3
❑
®
®
❑
❑
•
❑
❑
❑
❑
®
•
Code 3
ILLS
'
❑
•
•
❑
❑
IN
III
.
•
•
•
❑
s
s
•
❑
•
❑
❑
❑
•
•
•
❑
•
❑
y"
CC
e
•
0
•
0
•
•
0
0
•
0
0
0
i3.4C'
7
❑
❑
❑
•
❑
■
❑
❑
❑
❑
❑
■
act
CC
e
❑
•
❑
•
■
■
■
.
❑
■
•
❑
m
9
❑
•
❑
❑
•
III
.
•
•
❑
•
❑
-
10
❑
❑
❑
❑
•
•
•
❑
•
❑
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:10 /19/12
Shipped b FedEx
by:
Received b Date/Time:
by:
16:30
Relinquished by: Date/Time:
Shipped by:
Received by. aternme: iA /Z !I 4
maple Disposal: Return to Client • Lab Disposal ►:1
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