2013-03-13_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 3/13/2013
• Doc Name: GROUNDWATER DATA FOR FOURTH QUARTER 2012
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 3692013 61651089
Project Name: Schwartz -
DATE: 10/23/12 SSTF: S26614
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215-
Contact Name: Frank Adamic
ice: 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
l: 1- 719 - 275 -7413 ext 209
x: 1 -719- 275 -1669
Purchase Order #:
ELI Quote
Report Required For: POTWJ
Other
f Number of Containers
Sample Type:
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ANALYSIS REQUESTED
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
p additional charges
. and scheduling
Receipt Temp
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N
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Special Report Formats — ELI must be notified
prior to sample submittal for the follow
NELAC 0 A2LA 0 Level IV 0
Other
EDD /EDT 0 Format
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RUSH Turnaround
Comments:
S&A Schedule Code :
GW CODE:
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SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 MW - 00
10/23/12
14:30
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Custody
Record
MUST be
Signed
Relinquished by: Bob Tennan tDate/Time:10/24 /12 16:30
Shipped by: FedEx
Received by: Date/Time:
Relinquished b . Date/Time:
mW Y
Shi
Shipped by:
•
Received by Date/Time' i i :1 ' `o-2s -,
Sample Disposal: Return to Client • Lab Disposal ®
LABO TORY 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