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 61703009
Project Name: Schwartz - '
DATE: 12/26/12 SSTF: S26716 & S26717
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1750
Contact Name: Frank Adamic
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
Ary
209
Fax: 1
Purchase Order #:
ELI Quote #:
Report Required For PO11N/WWTP
Other
• 1
Number of Containers
Sample Type'
I-I AWSVBO
61r, Water $pits /Solids, Vegetation,
X §ioassay Qther
1
• - 1,.:::,
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
additional charges
t and scheduling
Receipt Temp
1-1.8 C
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra-226 total & dissolved CODE#3
1. elgel
_
Coolef ID(s}
Special Report
prior to sample
NELAC ❑
Other
EDD /EDT •
Formats — ELI must be notified
submittal for the following:
A2LA DI Level IV ❑
Format
Custodial
Y y 6)
Intact Y
Signaturrgg_
Y al)
Match LAB ID
YIN
RUSH Tumaround
Comments:
SBA Schedule Code :
SW CODE 1
Table 1
Frequency 1,
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
Time
1 SW - AWD
12/26/12
13:35
Water 1
0
❑
0
❑
■
■
❑
❑
❑
❑
=e
■
2 SW - BPL
12/26/12
13:45
Water 1
O
•
•
❑
•
■
•
•
❑
•
0
•
3
•
0
•
1
0
•
0
0
•
0
•
•
i.
4
■
■
■
❑
•
❑
•
❑
■
•
•
❑
5
•
❑
❑
•
•
❑
❑
•
❑
•
r�
(:ltaO&�rj
6
•
❑
❑
❑
•
•
•
•
❑
❑
❑
❑
-
•
❑
cc:
7
❑
•
❑
❑
❑
❑
•
❑
❑
❑
8
■
•
•
•
•
❑
❑
❑
■
•
1
•
9
■
■
•
•
■
❑
❑
■
■
❑
■
❑
....6
10
■
■
❑
■
❑
❑
❑
❑
•
•
❑
❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:12/26 /12 16 30
Shipped by: FedEx
Shipped by:
Received by: Date/Time:
Relinquished by: Date/Time:
Received by) Date/Time: t3b1 l la E,
Sample Disposal: Retum to Client ❑ Lab Disposal ►��
LABORATORY USE ONLY
Sample Type # of fractions
MEM Chain of Custody and Analytical Request Recora
L4BORATOR /L S
PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 1 of 1