2013-03-14_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 3/14/2013
• Doc Name: Surface Water Data for December 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 61702934
Project Name: Schwartz -
DATE: 12/12/12 SSTF: S26697 & S26698
Report Mail Address'
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -17
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
Anne Ary
1 3 ext. 209
Fax: 669
Purchase Order #:
ELI Quote #:
67
Report Required For: POTWNN
Other
Number of Containers
Sample Type.
—i AWSVBO
all Air, Water Soils/Solids, vegetation,
X Bioassay Qther
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
a additional charges
t and scheduling
__Jel
Receipt Temp
st ate-' C
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
H a -226 total & dissolved CODE#3
L elgpl
M D s
r
Special Report
prior to sample
NELAC ❑
Other
EDD /EDT •
Formats — ELI must be nc
submittal for the following
A2LA 0 Level IV
Format
Custod
Y /
c �
Intact
Y / N
Signature
Y / N
Match LAB ID
Y/N
RUSH Tumaround
Comments:
SS CODE Code :
Table 1
Frequency' 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
' SW - AWD
12/12/12
13:25
Water 1
0
■
■
■
■
a
■
■
BE
0
2 SW - BPL
12/12/12
13:35
Water 1
e
•
•
■
•
•
❑
•
• ■
►_
■
3
•
❑
D
•
❑
is
•
❑
i •
•
❑ _;.
4
0
0
•
•
•
•
a
❑
■ ■
■
■
5
•
•
D
■
❑
•
I l
i
W
O
0'.-.
6
•
❑
•
❑
•
❑
❑
❑
❑ •
0
•
: k
7
.
0
0
.
0
.
0
1
a ❑
❑
■
8
■
a
•
❑
i
•
❑
•
❑ i
■
❑
X
s
❑
■
■
a
i
•
in
■
❑ 1
❑
❑
10
•
0
0
•
0
■
■
❑
❑ a
■
0
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:12 /12/12 16 30
Shipped by: FedEx
Shipped by:
Received by: Date/Time:
Relinquished by: Date/Time:
Received b : Date/Time:12 t 2 �
Sample Disposal: Retum to Client ❑ Lab Disposal ►;�
LAB 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