2014-11-26_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 11/26/2014
• Doc Name: Water Quality Data and Mine Level Measurements for September 2014- Part 2.
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• 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 7710 9793 3090
DATE:W9H4 SSTF: S27676, S27677
Report Mail Address:
Sampler Name if other than Contact:
Cotter Corporation - Canon City Mill
Contact Name: Frank Adamic
1,3034342 -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
Involve Address:
Invoice Contact: JoAnne Ary
Purchase Order*
ELI Quote #t:
PO Box 1750
Tel: [phone] ext. 209
Canon City, CO 81215 -1750
Fax: [phone]
ANALYSIS
REQUESTED
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Custody
Relinquished by: Bob Tennant Daterrime:9/09/1416:30
Shipped by: FedEx
Received by. DeterTxne:
Record
Relinquished by: Date/Time:
Shipped by:
Received by: Date/Time 9 } 101 Ch
MUST be
Signed
Sample Disposal: Retum to Client ❑ Lab Disposal
LABORATORY USE ONLY
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