2013-01-28_HYDROLOGY - C1981008

• Permit No: C1981008
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/28/2013
• Doc Name: December 2012 DMRS ‎(CO-0000213)‎
• From: Western Fuels Colorado
• To: DRMS
• Permit Index Doc Type: DMR’s
• Email Name: MLT
• Email Name: SB1
• Media Type: D
• Archive: No

Client /Project Name: \n/i"sii_l 17 ( OLLCu applicable)
P.O. /Project Number: k),, j-012-1,:_z_00
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WET: Acute (Indicate Below)
WET: Chronic (Indicate Below)
WET. Accelerated (Indicate Below)
WET: PTI /TIE /TRE (Indicate Below)
•
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■
!Metals (List Below)
! !Solids (TS /TDS /TSS) (Circle) 1
! !Anions (List Below)
I !Chromium Ili /VI (Circle) J
■
Oil and Grease
l Coliform (Total /Fecal /E -Coli) (Circle)
BOD /COD (Circle) 1
Other Analysis (List Below)
[Number of Containers
Total Volume
JT_z_' I./AAA—
Contact: Q
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Address: 174,4
Phone # [phone]s `1 0
E -Mail: ")" J . Q Wr i1o3ii
Fax # ci 70 46 4 21 `$
Sampler: 7-17: iy
Report By: ❑ Mail _ nW ❑ FAX
Sample Location or ID
Date
Time
Grab/
comp
Lab ID
(LAB Use Only)
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• Turnaround Requirements
(Mahal al Test reaOnlvl
Test Species: 136thead Minnow y Ceriodaphnia ElDaphnia magna ❑ Daphnia pulex ❑ Other (List Below)
Standard (10
days)
6-9 Day
1 -2 Day
Special Instructions /Comments:
3 -5 Day
Requested Report Date:
Relinquished By
, •Received By (1):
Relinqu ish By. (2)
, .`Received Byte) >• i
Signature
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Date /Time
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Signature
Date/Time
Signature
Date /Time
Signature } , s r
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Date /Ti ;; me
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Crest rou
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CHAIN a CUSTODY
941 Cannon Street isville, CO 80027
(303) 661.E FAX [phone]