2014-10-09_HYDROLOGY - M1977300 ‎(3)‎

• Permit No: M1977300
• IBM Index Class Name: Hydrology
• Doc Date: 10/9/2014
• Doc Name: Water Quality Data and Mine Level Measurements for June 2014- Part 3.
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• Media Type: M
• Archive: No

Aw 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. 7?O3 :15--76 /$ !f DATE: 6/16/14 SSTF: S27576
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
Report Required For. POTWNWYrP❑ RUSH sample Receipt Temp
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Special Report Formats—ELI must be notified ..o w d additional charges
prior to sample submittal for the following: ��> 2t, and scheduling Custody eal
NELAC ❑ A2LA❑ Level IV Ely >? g Comments: Y/Other
EDD/EDT[I Format ` � o co S8A Schedule Code: Intact
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IDENTIFICATION Collection Collection ' � $ " Fr Match LAB ID
(Name, Location, Date Time Y/N
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0 Custody Relinquished by: Bob Tennant Date/Tim6/17114 16:30 Shipped by: FedEx Received by:__ Date/Time:
Record Relinquished by: Date/Time: Shipped by: Received by: )Date/Time: _ M
MUST be LABOFWTORY USE ONLY
Signed Sample Disposal: Return to Client❑ Lab Disposal® Sample Type #of fractions