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 61702750
Project Name: Schwartz -
DATE: 8/09/12 SSTF: S26555
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
719 - 275 -7413 ext. 209
Fax: -719- 275 -1669
Purchase Order #:
ELI Quote #:
Report Required For: POTWMANTP El
Other
Number of Containers
Sample Type:
-i AWSVBO
Air, Water Boils /Solids, Vegetation,
X Bioassay Qther
ANALYSIS REQUESTED
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
F additional charges
t and scheduling
Receipt Temp
S ` % a C
TABLE 2 - Footnote "2" applies
"
Cooler ID(s)
1 ct
Special Report Formats - ELI must be not
prior to sample submittal for the following:
NELAC 0 A2LA ❑ Level IV [
Other,
EDD /EDT ❑ Format
Custody Seal
Y / N
Intact
Y / N
Signature
Y/N
Match LAB ID
Y / N
RUSH Turnaround
Comments:
VIA Schedule Code :
GW CODE:
i=r
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1
•
•
1
.
0
0
.
.
0
❑
•
❑
s
2 Domestic Well
8/09/12
13:50
Water 6
®
•
•
•
■
■
■
D
.
❑
0
___
.
Q
3
•
❑
❑
•
❑
•
■
•
❑
❑
❑
•
I
4
•
❑
•
•
•
•
•
❑
❑
❑
•
❑
=
5
❑
•
•
•
•
❑
■
•
•
❑
0
0
CC
�G
CC
a
6
•
•
❑
❑
•
❑
•
■
•
■
o
'
•
0
0
•
•
0
0
0
0
•
0
8
❑
❑
•
❑
❑
❑
❑
❑
❑
❑
D
❑
CO
9
❑
❑
•
❑
.
❑
•
❑
❑
D
D
D
...e
10
❑
❑
❑
•
•
•
•
❑
❑
❑
.
.
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:8/09 /12 16:30
Shipped by: FedEx
Receiv r.,,DateITime: 1 7
Relinquished by: Date/Time:
Shipped by:
Received by: -- Date/Time: - /D -! ,'
Sample Disposal: Return to Client ❑ Lab Disposal 02
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
Page 18 of 19