2014-01-14_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/14/2014
• Doc Name: Surface water data and mine level measurements for November, 2013
• From: Cotter
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

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Iff" 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
Company Name: Cotter Corporation
Project Name: Schwartz -
Tracking No 808812015000555
DATE :1116!13 SSTF: S27253,S27255,S27256
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: 1- 719 - 275 -7413 ext. 209
Canon City, CO 81215 -1750
Fax: [phone]
Report Required For POTWNWUTP 0
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Notify ELI prior to
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SAMPLE
IDENTIFICATION
Collection
Collection
Match LAB ID
(Name, Location,
Date
Time
a
Y J N
Interval etc
MATRIX
' SW AWD
11 -6-13
1115
Water?
01010
®
❑
❑
O
❑
❑
❑
Fcm
❑
�-
2 SW-BOS
11-6-13
1310
Water 1
®
O
❑
❑
D
1 ❑
❑
❑
❑
❑
®
❑
3 SW-GS
11 -6-13
1325
Waterl
®
❑
❑
❑
I ❑
❑
❑
❑
❑
❑
®
❑
UJ
4
❑
1 ❑
❑
❑
113
113
D
❑
❑
❑
❑
O
5
D
10
❑
❑
10
❑
❑
O
❑
❑
0-71-31
6
D
❑
❑
❑
❑
❑
❑
O
❑
❑
❑
❑
7
❑
❑
❑
❑
❑
❑
O
❑
❑
O
O
O
8
O
❑
❑
O
❑
❑
❑
❑
❑
❑
❑
❑
9
❑
❑
❑
10 113
a
❑
a
❑
❑
10
[2
0
❑
❑
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1:3
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MP-1-
Custody
Relinquished by: Bob Tennant Date/Time:I1 /6/13 16:30
Shipped by: FedEx
Received by: Datefrime:
Record
MUST
Relinquished by. Data/Time,
Shipped by:
Received by: ataffime: r
be
Signed
Sample Disposal: Return to Client ❑ Lab Disposal ®
LABORA11ORY USE ONLY
Sample T # of fractions