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 61702965
Project Name: Schwartz -
DATE: 12/18/12 SSTF: S26754 & S26755
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -175
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: POTVV/WWTP 0
Other
Number of Containers
Sample Type:
AWSVBO
Air, Water $oils/Solida, vegetation,
XC Bioassay Qther
ANAL YSES nk 4 r i.
Normal Tumaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
P additional charges
t and scheduling
Receipt
Temp
C
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra -226 total & dissolved CODE#3
L elgei
Cooler ID(s)
Special Report
prior to sample
NELAC II
Other
EDD /EDT
Formats - ELI must be notified
submittal for the following:
A2LA A2LA 0 Level IV
0 Format
Custody
Y / Se
Intact
Y /6)
Signaire
Y N
Mat LAB ID
Y N
RUSH Turnaround
Comments:
S&A Schedule Code :
SW CODE I 1
Table 1
Frequency 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW - AWD
12/18/12
10:20
Water 1
►-_
•
❑
❑
•
•
❑
❑
•
❑
0
T
❑..
',:t..
2 SW - BPL
12/18/1
10:35
Water 1
®
❑
•
•
•
•
•
0
❑
•
•
:
3
•
•
❑
•
•
❑
•
❑
0
•
0
❑
14
tal
4
❑
.
•
•
❑
❑
❑
❑
•
•
❑
•
5
•
•
❑
•
❑
•
•
•
•
•
•
0
6
❑
•
■
•
•
❑
❑
❑
❑
•
•
C k �t,�t
7
❑
❑
❑
•
❑
❑
❑
•
❑
❑
•
❑
8
❑
•
❑
•
❑
❑
•
❑
•
•
❑
•
`
9
❑
❑
•
❑
III
•
❑
•
❑
❑
•
•
10
•
❑
❑
❑
•
❑
❑
•
•
•
•
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:12/18 /12 16 30
Shipped b.edEx
Shipped by:
Received by: t!,, Date/Time:12 1ct--(
Relinquished by: Date/Time:
Received by: Date/Time: 10'.
Sample Disposal: Return to Client 0 Lab Disposal ►Zi
LABORATORY 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