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 62583488
Project Name: Schwartz -
DATE: 1/22/13 SSTF: S26784 & S26785
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1750
Contact Name: Frank Adamic
5 -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:
Purchase Order #:
ELI Quote #:
' ^�� 32x-6;
Report Required For: POTWNWITP
Other
Number of Containers
Sample Type:
AWSVBO
eir, Water ,goils/So ds, Vegetation,
�C gioassay Qther
Normal Turnaround (TAT)
Notify ELI prior to
RUSH sample
submittal for
p additional charges
t, and scheduling
Receipt Temp
o C
U - dissolved only - CODE #1
U - total & dissolved - CODE #3
Ra -226 total & dissolved CODE#3
Table 1
Cool 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 gal
Y /
Intact
Y / N
Signature
Y / N
Match LAB ID
YIN
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
SW - AWD
1/22/13
13:35
Water 1
CI
•
•
❑
_
•
•
❑
•
•
•
► -.
•
2 SW-BPL
1/22/13
13:45
Water 1
e
•
❑
❑
❑
■
■
D
❑
■
®
■
3
❑
❑
•
•
•
❑
•
❑
❑
•
D
•
t'.V3D1 0t4
'-.;.
4
❑
•
•
❑
■
•
•
•
❑
•
•
•
-.
5
0
•
0
•
0
•
0
0
0
0
0
0
6
•
❑
•
❑
•
'
•
❑
•
•
•
D
�---
•
•
D
t F
,i,
7
0
0
0
N
•
•
•
•
❑
❑
8
❑
❑
•
•
•
•
•
•
❑
•
❑
•
9
•
•
❑
■
•
❑
•
■
•
1
0
0
_h..
,o
❑
•
❑
❑
❑
•
•
❑
•
❑
•
■
Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:1 /22/13 16:30
Shipped by: FedEx
Received by: Date/Time:
Relinquished by: Date/Time:
Shipped by:
Received by: f , Date/Time: ^. J
Sample Disposal: Return to Client • Lab Disposal ®
LABORATORY USE ONLY - t
Samp Type # of fractions
firilig7 Chain of Custody and Analytical Request Record
mmigim
PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 1 of 1