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 61702842
Project Name: Schwartz -
DATE: 11/16/12 SSTF: 526704
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -17;
Contact Name: Frank Adamic
9- 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
Anne Ary
3 ext. 209
Fax: 669
Purchase Order #:
ELI Quote #:
Report Required For. POTWNW
Other
j f Number of Containers
Sample Type:
-1 AWSVBO
Sir, Water $oils/Sdids, Vegetabon,
l X Bioassay Ober
ANAL` S S Rr: vIASTTE
Normal Tumaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
p additional charges
i. and scheduling
Receip Tpmp
C
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra-226 total & dissolved CODE#3
L algal
Cooler ID(s)
C { '�A'
Report Formats — ELI must be notified
prior to sample submittal for the following,
NELAC ❑ A2LA • Level IV
Other
EDD /EDT ❑ Format
•
Custody ea!
Y /
Intact
Y
Signe
Y /
Match B
YI
RUSH Tumaround
Comments:
SSA Schedule Code :
SW CODE I1
Table 1
Frequency 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1
.
❑
■
■
■
■
❑
❑
■
■
, ■
■
2 SW -BPL
11/16/12
10:00
Water 1
0
.
❑
❑
❑
❑
❑
❑
•
❑
❑
3
•
.
•
❑
❑
•
.
❑
•
❑
•
❑
ifs
4
00
•
.
■
IN
•
■
■
❑
■
5
■
•
❑
❑
•
•
•
•
1
•
0
•
>
6
•
•
❑
•
❑
❑
•
•
•
•
❑
❑
CIWtOtO
7
❑
•
•
•
❑
•
•
•
❑
•
•
•
CC
8
•
•
•
•
•
•
❑
❑
❑
•
•
❑
CO
9
.
.
❑
❑
•
•
❑
❑
❑
❑
•
❑
-
10
.
❑
❑
❑
.
❑
❑
❑
❑
■
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:11 /16/12 16 30
Shipped by: FedEx
Shipped by:
Received by: Datefine:
Relinquished by: Date/Time:
Received by: Date/Time: j 1- 1Gi- /c',
Sample Disposal: Return to Client ❑ Lab Disposal 0
LABO ORY USE ONLY
Sample Type # of fractions
LABORATORIES
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