2012-12-14_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/14/2012
• Doc Name: Surface Water Data for September 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 3892013 618523287
Project Name: Schwartz -
DATE: 9126112 SSTF: 526565
Report Mae Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1750
Contact Name: Frank Adamic
Voice: 1-719-275 -7413 ext. 204
Sampler Name if other than Contact
1-303-642-3893 mine phone
Bob Tennant 1- 719-371- 3009-cel
Invoice Address:
PO Box 1750
Canon City, CO 81215 -1750
m e Ary
Kt. 209
Fax: [phone]
Purchase Order #:
ELI Quote #:
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ANALYSIS REQUESTED
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
< additional charges
b and scheduling_
_
Rec
o
6 ID( a
Report Required For: POTWNWV
Other
U - dissolved only - CODE 01
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£0W303 P•NoselP mw SZZ
I. *MU
Special Report Formats — ELI must be notified
prior to sample submittal for the following:
NELAC 0 A2LA ❑ Level IV 0
Other
EDD/EDT 0 Format
Custody
Y
Intact
Y / N
Signature
Y / N
Match LAB ID
Y / N
punaewnl HSnw
Comments:
S&A Schedule Code :
SW CODE I 1
Table 1
Frequency/ 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
'
•
❑
❑
❑
0
0
0
0
0
.
..■•■
0
0
2 SW-81k
9/26/12
8:00
Water!
.
❑
❑
❑
❑
❑
❑
❑
❑
❑
-,
-
❑
Code 1
.,
Z
3
❑
❑
❑
•
❑
❑
❑
❑
❑
❑
❑
❑
4
❑
❑
❑ ,
•
❑
❑
❑
❑
❑
❑
❑
❑
5
■
❑
❑
❑
❑
•
•
❑
❑
❑
❑
•
>,-
6
❑
❑
❑
❑
0
❑
❑
❑
❑
❑
❑
❑
F .._ •..r
7
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
oc
8
❑
❑
❑
❑
❑
•
❑
❑
❑
•
❑
❑
m
❑
❑
❑
•
•
❑
❑
❑
❑
❑
©
J
10
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
t
Custody
Record
MUST be
Signed
ReInquished by: 80b Tennant Date(Time:9/26/12
Shipped by: FedEx
Stripped by:
Received by: DatelTime:
Relinquished by DatelTime:
Received by: Datelrime: gas
Sample Disposal: Return to Client 0 Lab Disposal El
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 1011