2015-06-17_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 6/17/2015
• Doc Name: Water Quality Data and Mine Level Measurements for April 2015
• From: Cotter Corporation
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

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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 7732 8113 9132
DATER/02115 SSTF: S27828
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]
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4/02115
11:30
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Custody
Relinquished by: Bob Tennant Daterrime:4/02/15 16:30
Shipped by: FedEx
Received by: Date/Time:
Record
Relinquished by: Date/Time:
Shipped by:
Received by-.MC� Dater ime:'06� !,!
MUST be
Signed
Sample Disposal: Return to Client ❑ Lab Disposal ®
LABORATORY USE ONLY
Sample Type # of fractions