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: 826694 & $26695
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1
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
JoAnne Ary
13 ext. 209
F ax: 669
Purchase Order #:
ELI Quote #:
_ ii _
Report Required For: POTVVANWTP
Other
Number of Contains
Sample Type:
—1 AWSVBO
/ Air Water $oils/Solids, Yegetation,
X @loassay Qther
ANA a s i= - 001 .`.T;::..=
Normal Tumaround (TAT)
1
Notify ELI prior to
RUSH sample
submittal for
a additional charges
b and scheduling
Receipt Temp
_, %_ o C
U - dissolved only - CODE #1
I U - total & dissolved - CODE #3
Ra-226 total & dissolved CODE#3
SEE ATTACHED TABLE 1
_
Co�olletr ID(s
Special Report Formats — ELI must be notified
prior to sample submittal for the following:
NELAC ❑ A2LA ❑ Level 1
Other
EDD /EDT ❑Format
Custody Seal
Y /6)
Intact
Y / N
Signature
Y / N
Match LAB ID
YIN
RUSH Tumaround
Comments:
SSA Schedule Code :
SW CODE 1 3
Table 1
4,
Two
Two co
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etcl
Collection
Date
Collection
Time
' SW FBRG
12/12/12
9:55
Water 3
❑
❑
•
❑
•
•
❑
® 1
•
Code 3
2 SW ARH
12/12/12
10:10
Water 3
0
cl
0
•
❑
❑
■
❑
•
❑
_o
•
Cade 3
3
❑
❑
❑
•
❑
❑
•
•
•
•
•
❑
Lial
4
❑
•
❑
❑
❑
❑
•
❑
•
•
•
❑
=
5
•
a
0
•
•
•
•
0
0
0
_ _ •ell
6
0
•
•
0
0
•
0
0
0
0
O
,
7
•
•
❑
❑
•
•
❑
❑
❑
•
�
❑
8
❑
❑
❑
❑
•
❑
❑
❑
•
•
❑
•
0
C
9
•
•
•
0
•
0
0
0
•
0
1 1
0
10
•
0
0
0
0
•
•
❑
•
❑
❑
❑
Custody
MUST d
Si
Signed
9
Relinquished by: Bob Tennant Date/Time:12/12/12
Shipped by: FedEx
pre y '
Received by: Date/Time:
y '
16:30
Relinquished by: Date/Time:
Shipped by:
Received by: Date/me: , )2_
Sample Disposal: Return to Client ❑ Lab Dispos ®
LAB in. TORY USE ONLY
Sample Type # of fractions
jOiTafiCely
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