2015-01-28_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: Hydrology
• Doc Date: 1/28/2015
• Doc Name: Water Quality Data and Mine Level Measurements for November 2014
• From: Cotter
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

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: Schwab-
Tracking No 7713 4530 6686 DATE:10/01/14 SSTF: SV707
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 81216-1750 Voice: 1-719-275-7413 ext. 204 Bob Tennant 1-719-371-3009-cell
Invoice Address: Invoice Contact: JoAnne Ary Purchase Order#: ELI Quote t
PO Box 1750 Tel: [phone] ext. 209
Canon City,CO 81215-1750 Fax: [phone]
ANALYSIS REQUESTED Notify ELI prior to Race T
Report Required For. POTWNVWTP❑ RUSH sample o C
Other submittal for ler ID(s)
Special Report Formats—ELI must be notified c t ` additional charges
prior to sample submittal for the following-: t and schedulln Custody
NELAC[IA2LA[I Level IV❑ �, Comments: Y/�
Other i, S8A Inc
EDD/EDT❑Format s F Schedule Code
_ F SW CODE 11 Y/N
SAMPLE = Table 1 Signature
IDENTIFICATION Collection Collection Frequency 1, Y/N
(Name, Location, Date Time Match LAB ID
Interval etc) MATRIX
> > Y/N
' SW AWD 10/01/14 9:00 Water 1 ❑ O ❑ ® ❑ 1 ❑ ❑ ❑ ❑ ❑ ® D y-
2 ❑ D ❑ ❑ O lo ❑ ❑ ❑ ❑ c3i ❑
3 ❑ ❑ ❑ ❑ ❑ I ❑ D D ❑ ❑ ❑ I ❑ W
4 ❑ O ❑ ❑ ❑ 10 ❑ ❑ ❑ ❑ ❑ ❑
5 ❑ ❑ ❑ ❑ ❑ ❑ ❑ D O ❑ D ❑
s ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ D O ❑ ❑
7 ❑ O ❑ ❑ ❑ ❑ ❑ O ❑ O ❑ ❑
8 1 ❑ ❑ ❑ D ❑ 10 10 ❑ ❑ ❑ 13113 ,
m
9 ❑ ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ❑ ❑ --�
° +n ❑ ❑ ❑ ❑ ❑ D D D ❑ O ❑ D
D
a Custody Relinquished by:M Tennant Date/Time:10101/1416:30 Shipped by:FedEx Received by: Dater ime:
P Record Relinquisted by: Deteft ime: Shipped by: Received by Datelfime:
MUST be
Signed Sample Disposal: Return to Client❑ Lab Disposal t*,TORY USE ON1 Y
Sample TYP2 e of fractions