2012-12-17_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/17/2012
• Doc Name: Groundwater Data for Third Quarter 2012- Section 1
• 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 61650884
Project Name: Schwartz -
DATE: 7/20/12 SSTF: S26541
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1
Contact Name: Frank Adamic
e: 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
1- 719 - 275 -7413 ext. 209
: 1 - 719 - 275 - 1669
Purchase Order #:
ELI Quote #:
f t-k'
Report Required
Special Report
prior to sample
NELAC ❑
Other
EDD /EDT 0
For: POTW/ll
Other
r
I'
g Number of Containers
Sample Type:
AWSVBO
X Air, }dater § Soils /Solids, yegetation,
K Bioassay other
ANALYSIS REa:.JE.STED
Normal Turnaround (TAT) ! I
F
b
RUSH Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
and scheduling
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Cooler ID(s
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Formats — ELI must be
submittal for the following:
A2LA ❑ Level
Format
Custody 0/I
Y /
Intact
Y / N
Signature
Y 1 N
Match LAB ID
Y / N
Comments:
S&A Schedule Code :
GW CODE:
Fre uenc :
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
D
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Custody
Record
MUST be
Signed
Relin.uished b :: •b Tennant Date/Time:7/20 /12 16 30
Shi• •ed b : FedEx
Received b : Date/Time:
Relinquished by: Date/Time:
Shipped by:
Received by: j PP. . - - 9,
/ • }.,m- / �
-
Sample Disposal: Return to Client ❑ Lab Disposal
LABORA V RY USE ONLY
Sam.1e T •e # of fractions
0
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