2014-03-05_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 3/5/2014
• Doc Name: Surface water data and mine level measurements for December 2013
• 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 1
Company Name: Cotter Corporation
Project Name: Schwartz - =
Tracking No.8088120 15000708
DATE: 12111/13 SSTF: 527332
Sampler Name if other than Contact:
Report Mail Address:
Cotter Corporation - Canon City Mill
Contact Name: Frank Adamic 1 -303- 642 -3893 mine phone
Bob Tennant 1- 719 - 371 -3009 -cell
PO Box 1750; Canon City, CO 81215 -1750
Voice: 1 -719- 275 -7413 ext. 204
Purchase Order #: ELI Quote #:
Invoice Address:
Invoice Contact: JoAnne Ary
PO Box 1750
Tel: [phone] ext. 209
Canon City, CO 81215 -1750
Fax: [phone]
Notify ELI prior to
Receipt Temp
Report Required For PO'NW/WWTP ❑
submittal for sample
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Other
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additional charges
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Special Report Formats — ELI must be notified
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and schedulin
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prior to sample submittal for the following:
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NELAC ❑ A2LA ❑ Level IV ❑
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SAMPLE
IDENTIFICATION
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Date
Time
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MATRIX
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1 Mine Refdl
12 -11 -13
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Custody
Relinquished by: Bob Tennan DatelTiml2/11 /1316:30 Shi ed b : FedEx Received by Dalefrime:
Received by: ID Date/Time:
Record
Relinquished by: DatefTime: Shipped by:
LABORATORY USE ONLY
MUST be
Signed
Signed
Sample Disposal: Return to Client ❑ Lab Disposal ® Sample T # of fractions —