2013-01-16_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/16/2013
• Doc Name: Surface Water Data for November 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 61702873
Project Name: Schwartz -
DATE: 11/29/12 SSTF: S26709 & S26710
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -175
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 -cell
Invoice Address:
PO Box 1750
Canon City, CO 81215 -1750
Invoice Contact JoAnne Ary
3 ext. 209
Fax: 669
Purchase Order #:
ELI Quote #:
Report Required For. POTVV/WWTP
Other
II
Number of Containers
Sample Type:
AWSVBO
Air, Water $oilWWSolids, kegetation,
X flioassay Qther
ANALYSIS REQUESTED
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
i= additional charges
. and scheduling
Receipt Temp
C
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra-226 total & dissolved CODE#3
oriel
Cooler ID (s)
Special Report Formats - ELI must be notified
prior to sample submittal for the following:
NELAC ❑ A2LA ■ Level IV
Other
EDD /EDT ❑ Format
Custody Seal
Y / N
Intact
YI
Signature
Y / N
Match LAB ID
Y / N
RUSH Turnaround
1 Comments:
S&A Schedule Code :
SW CODE 11
Table 1
Frequency 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW - AWD
11/29/12
10:05
Water 1
•
•
❑
❑
•
•
❑
❑
❑
c ■
w
•
2 SW
11/29/12
10:20
Water 1
:1
•
•
•
•
•
•
•
•
❑
®
•
Z
a
3
•
❑
•
❑
•
•
•
•
•
•
❑
•
w
4
•
•
■
•
•
❑
•
❑
•
0
0
•
=
5
❑
❑
■
•
•
•
■
•
❑
■
0
g13 i i i /C25
8
•
❑
•
•
•
❑
❑
•
❑
•
❑
•
IF
7
❑
❑
•
❑
•
❑
❑
❑
❑
❑
❑
❑
CZ
8
0
0
0
0
•
0
0
0
•
•
O
•
co
ml
9
❑
❑
•
❑
•
•
•
❑
❑
❑
❑
❑
cr
--JI
10
❑
❑
•
•
•
❑
❑
❑
❑
❑
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:11/29/12 16 30
Shipped by: FedEx
Shipped by:
Received by: Date/Time:
Relinquished by: Date/Time:
Received byem, Date/Time: //- 3O -I Z
S S
Sample Disposal: Return to Client ❑ Lab Disposal CI
LABOORY 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