2014-05-08_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/8/2014
• Doc Name: Water quality data and mine level measurements for February 2014
• From: Cotter Corporation
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

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C ustody 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 7978 5245 6255
DATE:2/07 /14 SSTF: 527324, S27325
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]
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2/07/14
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Custody
Relinquished by: Bob Tennant Date/Time:2 /07/1416:30
Shipped by: FedEx
Received by: Date/Time:
Record
Relinquished by: Date/Time:
Shipped by:
Received b Date/Time* .�
MUST be
Signed
Sample Disposal: Return to Client ❑ Lab Disposal ®
LABO TORY USE ONLY
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