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

AEFChain 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.7770 3775 7440 DATE:8/19/16 ssTF: S29149
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 1760 Tel: [phone] ext. 207
Canon City,CO 81215-1750 Fax: [phone]
AN%V.YSE REQUESTFV Notify ELI prior to Recei t Temp
Report Required For. POTWNWVTP[:1 RUSH sample 'too C
Other submittal for p(
Special Report Formats—ELI must be notified .. S a F additional charges C , �.��✓0�
prior to sample submittal for the following: gm and schedulin
NELAC❑ A2LA❑ Level IV❑ �', Comments: Custody I
Other a — E e Intact
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h S&A Schedule Code:
a GW CODE: Y/N
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SAMPLE N o . 0 Sin YIN
IDENTIFICATION Collection Collection v, F Match LAB ID
(Name, Location, Date Time i8 y •c Y/N
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Record Relinquished by: Date/Time: Shipped by: Received by: Date/Time:
4 MUST be LABORATORY USE ONLY
Signed Sample Disposal: Return to Client❑ Lab Disposal
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