2013-11-26_HYDROLOGY - M1977300 ‎(4)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 11/26/2013
• Doc Name: Water Data for September 2013 - 3
• From: Cotter
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

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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 I
Company Name: Cotter Corporation
Project Name: Schwarz -
Tracking No. $ 0 $912.0 15 0a0Zy)
DATE: 9/23/13 SSTF: S27095
Report Mail Address:
Sampler Name if other than Contact;
Cotter Corporation - Canon City Mill
Contact Name: Frank Adamic
1 -303 -642 -3893 mine phone
PO Box 1750; Canon City, CO 81215 -1750
Voice: 1- 719 -275 -7413 ext. 204
Bob Tennant 1 -719- 371 - 3009 -cell
Invoice Address:
Invoice Contact JoAnne Ary
Purchase Order #:
ELI Quote #:
PO Box 1750
Tel: [phone] ext. 209
Canon City, CO 81215 -1750
Fax: [phone]
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Custody
Relinquished by: Bob Tenn n Date/Time:9/23 /1316:30
1 Shipped
by: FedEx
Received by: Datelrime:
Record
Relinquished by: Date/Time:
I Shipped by:
Received by: Date/Time:
MUST be
Signed
Sample Disposal: Return to Client ❑ Lab Disposal ®
LABORATORY USE ON
Sample Type # of fractions