2012-12-17_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/17/2012
• Doc Name: Groundwater Data for Third Quarter 2012- Section 2
• 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 61650907
Project Name: Schwartz -
DATE: 7/26/12 SSTF: 526523
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
Fax: 1 - 719 - 275 - 1669
Purchase Order #:
ELI Quote #:
i L %
Report Required
Special Report
prior to sample
NELAC ❑
Other
EDD /EDT ❑
For: POTW/lh
Other
n
I1
C Number of Containers
-I Sample SVBO
gir, Water $ots/Solids, Yin.
X !Foamy Qther
ANALYSiS REQUESTED
Normal Turnaround (TAT)
F
.
RUSH Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
and scheduling
Receipt Temp
15� Y °C1
TABLE 2 - Footnote "2" applies
•
rm
Formats — ELI must be
submittal for the following:
A2LA ❑ Level
Format
Cooler
Cl ID(s) �
s )
Custody Seal
Intact
Y / N
Signature
Y/
Match LAB ID
Y / N
Comments:
SBA Schedule Code :
GW CODE:
Fre uency:
��
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Tirne
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2 MW
7/26/12
13:05
Water 6
®
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0
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=
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INC
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Custody
Record
MUST be
Signed
9
Relinquished by: Bob Tennant Date/Time:7/27 /12 16:30
Shipped by: FedEx
Received by: Date/Time:
Relinquished by: Date/Time:
Shipped by:
/
Received by: Date/Time: 1 1 ` X-5 .
Sample Disposal: R to Client 0 Lab Dis
LABORATORY USE ONLY iii"'
Sample Type # of fractions
CI
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
OZ 40 61. afied