2008-10-22_REPORT - C1981008 ‎(3)‎

• Permit No: C1981008
• IBM Index Class Name: REPORT
• Doc Date: 10/22/2008
• Doc Name: 2008 AHR Appendix C Part 3
• From: Western Fuels-Colorado
• To: DRMS
• Annual Report Year: 2008
• Permit Index Doc Type: Hydrology Report
• Email Name: MLT
• Media Type: D
• Archive: No

tip
CHAIN OF CUSTODY RECORD
? SG S®rth America Inc.
I.tii501-A East Patapsco Avenue Baltimore, MD 21226 Tel: [phone] Fax: [phone]
4;:Jie:°I3 850 Sophia, WV 25921 Tel: [phone] Fax: [phone]
t..216 Oxmoor Circle Birmingham, AL 35209 Tel; [phone] Fax: [phone]
L`5793 MacCoride Avenue SE Charleston, WV 25304 Tel: [phone] Fax: [phone]
I mr rr
•
0 2979 East Center Street Conneaut, OH 44030 Tel: [phone] Fax: x,4) 224-2808
O 1101 Howard Drive Deer Park, TX 77536 Tel: [phone] Fax: [phone]
0 4665 Paris Street, Suite B-200 Denver, CO 80239 Tel: [phone] Fax: [phone]
0 2804 Hackathorne Lane Gillette, WY 82716 Tel: [phone] Fax: [phone]
0 Route 2, Box 162A Middlesboro, KY 40965 Tel: [phone] Pax: [phone]
0 15550 N. Lombard - Terminal 5
' Portland, OR 97203 Tel: [phone] Fax: [phone]
0 16130 Van
Drunen Road South Holland, IL 60473 Tel: [phone] Fax: [phone]
SGS Re efnce:
I :r hl1P?r I; t j ? q 6 I
y0 PHONE NO:( L70) l r 4? l(J ...
i OJi ( i SITE/PWSID# : N o SAMPLE used rvaUres /
i ' PCI7i ;TO: C Anall
R
c? X
i f O C-
COMP eqL
A

FAX NO.:(? fit)) D L4 Z
6142-4 N

T
i L.I;:Oli:r: f0: 244Y SZc(eu$, QUOTE 9: A G.
GRAB
P.O. NUMBER: N
i ?, II:S';tt!l:?, '?.a?2t34II_W.9riitW, ? r

SAMPLE IDENTIFICATION DATE TIME MATRIX
I J
R
;f
;k-Ra 329 came:. . asap
uller.h:: Relinqui ed By:(1)
(Jin-, ;nedd :3'y: (2)
I
oiimw.:hed ?3y: (3)
: olinqu died :3.y: (4)
11301 s w 1 2 1 G

Date
10.&A
Date
Date
PAGE____L_OF 9
REMARKS
Time Received By: Shipping Carrier: U Samples Received Cold? (Circle YE NO
200 v
Shipping Ticket No: Temperature C: .
Time Received By-
Special Special Deliverable Requirements: Chain of Custody Seal: (Circle)
INT BROKEN ABSENT
Time Received By: ( Requested Turnaround Time and Special Instructions:
..a. VatIm
1 .(: . NRV