2013-03-18_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 3/18/2013
• Doc Name: Surface Water Data for January 2013
• 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 62583433
Project Name: Schwartz -
DATE: 1/09/13 SSTF: S26801 & S26802
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
3 ext. 209
Fax: )69
Purchase Order #:
ELI Quote #:
.y -- ( 1
f Number of Containers
Sample Type;
-I AWSVBO
Air, Water Eoils/Solids, Vegetation,
' X gloassay Other
ANA :.,s:y M :::t3:: - ,,)
Notify ELI prior to
RUSH sample
submittal for
P additional charges
. and scheduling
__S
Receipt Temp
i i U °C
D
Report Required For: POTWANWTP
Other
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra -226 total & dissolved CODE#3
Table 1
er ID(s)
Special Report Formats — ELI must be notified
prior to sample submittal for the following:
NELAC ❑ A2LA ❑ Level IV
Other
EDD /EDT ❑ Format
•
Custody Seal
Y/N
Intact
Y / N
Signature
Y / N
Match LAB ID
Y / N
Normal Turnaroun
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
1/09/13
13:10
Water 1
0
•
❑
❑
❑
❑
❑
•
in
•
0 0
2 SW-BPL
1/09/13
13:25
Water 1
0
•
❑
❑
•
❑
•
❑
❑
❑
ID ❑
0
3
•
•
❑
•
❑
❑
•
•
•
❑
❑ •
4
❑
•
❑
•
❑
❑
•
•
•
❑
• •
5
❑
•
❑
❑
•
•
•
•
❑
■
• ❑
6
•
•
❑
•
•
•
❑
•
•
•
• ❑
` - .3, i
7
❑
❑
❑
❑
•
•
❑
•
•
❑
❑ ❑
- 0
CICc
8
•
❑
❑
•
❑
•
•
•
•
•
• ❑
9
•
❑
•
i
❑
•
❑
❑
i
■
■ ❑
10
❑
❑
■
•
❑
❑
❑
❑
•
O
❑ ❑
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:1 /10/13 16:30
Shipped by: FedEx Received by: Date/Time:
Relinquished by: Date/Time:
Shipped by: Received by: - Date/Time: j )113/9
LABORATORY USE ONLY
Sample Disposal: Return to Client 0 Lab Disposal ® Sample Type # of fractions
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