2014-08-07_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: Hydrology
• Doc Date: 8/7/2014
• Doc Name: Water Quality Data and Mine Level Measurements for May 2014, Part 2.
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• Media Type: D
• Archive: No

Chain of Custody and Analytical Request Record
'W PLEASE PRINT; provide as much information as possible Refer to corresponding notes on reverse side. Page 1 of 1 4
Company Name: Cotter Corporation Project Name: Schwartz -
Tracking No.7700 5440 9450 DATE: 5/21/14 SSTF: S2751 1
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]
Notify ELI prior to
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SAMPLE € N " € Signature
IDENTIFICATION Collection Collection °° Y/fd'
(Name, Location, Date Time m N a F uen Match LAB ID
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Custody Relinquished by: BQb Tennant DatetTimS/21/14 16:30 Shipped by: Fed Ex Received by- Date/Time:
Record Relinquished by: Date/Time: Shipped by: Received by: Date/Time: t4 I i
MUST be LABORATORY USE ONLY
Signed € Sample Disposal: Return to Client❑ Lab Disposal® Sam le Type #of fractions