2016-10-24_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 10/24/2016
• Doc Name: Water Level Monitoring
• From: Cotter Corporation
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

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 - S29142
Tracking No.7770 2001 3745 DATE: 8/17/16 SSTF:S29099,
Report Mail Address: Sampler Name if other than Contact:
Cotter Corporation-Canon City Mill Contact Name: Nate Lambert 1-303-642-3893 mine phone
PO Box 1750;Canon City,CO 81215-1750 Voice: 1-719-275-7413 ext. 208 Bob Tennant 1-719-371-3009-cell
Invoice Address: Invoice Contact Lori Simpson Purchase Order#: ELI Quote#:
PO Box 1750 Tel: [phone] ext. 207
Canon City,CO 81215-1750 Fax: [phone]
ANALYS-z REOUESTED Notify ELI prior to
Report Required For: POTW/WWTP[I RUSH 3
sample Reo Temp
. -C
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submittal for Cooler ID(s)
Special Report Formats—ELI must be notified V..° a p additional charges
prior to sample submittal for the following: 3m'� t and schedulingCu I
NELAC❑ A2LA❑ Level IV❑ a Q g Comments: Y
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Other
EDD/EDT❑Format EE ` F S&A Schedule Code: Intact
z — 9GW CODE: Y/N
SAMPLE N Signature
IDENTIFICATION Collection Collection Y/N
m F Match LAB ID
(Name,Location, Date Time � Y/N
Interval,etc) MATRIX
+ U P9 8117/18 9:50 Water 3 ® 01010 ❑ ❑ ❑ D ❑ ❑ ® ❑ 1 See attadmd �.
2 SUMP8 8/17116 14:35 Water 3 o 01010 ❑ o ❑ ❑ O 1 ❑ ® ❑1 See attached Z
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❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11 . 0 ❑
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❑ ❑ ❑ D ❑ 010 , 0 ❑ ❑ D ❑ c
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Custody Relinquished : T nn DateMme:8/17/1616:00 Shi by:FedEx Received by: Date/Time:
= Record Relinquished by: Date/Time: Shipped by: Received by: Daterri tilts ti, 1
MUST be LABORATORY USE ONLY
Signed Sample Disposal: Return to Client❑ Lab Disposal® Sample T #of fractions