2014-10-09_HYDROLOGY - M1977300 ‎(4)‎

• 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 4.
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• Media Type: D
• Archive: No

ain of Custody and Analytical Request nRecord
PLEASE PRINT; p reverseotes on side. Page 1 of 1
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Company Name: cotter corporation Project Name: Schwartz-
Tracking No.7704 2259 8655 DATE: 6/25/14 SSTF: S27548 Sampler Name if other than Contact:
Report Mail Address: 1-303-642-3893 mine phone
Contact Name: Frank Adamic Bob Tennant 1-719-371-3009-celi
Cotter Corporation-Canon City Mill 1-719-275-7413 ext. 204
PO Box 1750; Canon City,CO 81215-1750 Voice: Purchase Order-lot 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
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submittal for Cooler ID(s)
Report Required For: POTWNVW TP e a additional charges
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Custody DatelTime: Shipped by: LABORATORY USE ONLY
Record Relinquished by: #vne of fractions
MUST be Return to Client❑ Lab Disposal® Sam le T
Signed Sample Disposal: