2009-07-22_HYDROLOGY - C1981008

• Permit No: C1981008
• IBM Index Class Name: HYDROLOGY
• Doc Date: 7/22/2009
• Doc Name: June 2009 DMRs and WET Test
• From: Western Fuels-Colorado
• To: CDOH WQCD
• Permit Index Doc Type: DMR’s
• Email Name: MLT
• Media Type: D
• Archive: No

CHAIN OF CUSTODY RECORD -12979 East Center Street Conneaut, OH 44030 Tel: [phone] Fax. [phone]
-SG$
SGS North America Inc. J 1101 Howard Drive Deer Park, TX 77536 Tel: [phone] Fax: [phone]
- J 4665 Paris
J 1501-A East Patapsco Avenue Baltimore, MD 21226 Tel: [phone] Fax: [phone] J 2804 Hack tho ne Lane B 2? GDenver, CO 80239 Tel [phone] Fax illette, WY 82716 Tel:
[phone] Fax: [phone]
J P O. Box 850 Sophia, WV 25921 Tel: [phone] Fax: [phone] J Route 2, Box 162A Middlesboro, KY 40965 Tel: [phone] Fax. [phone]
J 216 Oxrnoor Circle Birmingham, AL 35209 Tel: [phone] Fax: [phone] J 15550 N. Lombard - Terminal 5 Portland, OR 97203 Tel: [phone] Fax: [phone]
J 579:3 MacCorkle Avenue SE Charleston, WV 25304 Tel: [phone] Fax: [phone] J 16130 Van Drunen Road South Holland, IL 60473 Tel: [phone] Fax: [phone]
1
CLIFNT:
?L ??L SGS R f rence: ?
CONTACT: 10. PAGE?_OF__.l
' PHONE NO:(O'a) Q! ?W- qo

PROJECT SITE/PWSID# : No SAMPLE
Preservatives
used
TYPE
REPORTS TO' ?r !'F C Analysis

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O
COMP Require]

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INVOICE TO: M iN S CJC?&L -S QUOTE #: --^ A G=
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LAB NO SAMPLE IDENTIFICATION
DATE
TIME
MATRIX R
S
REMARKS
a '
t I! S S W Z o rIZ
? t
?,ouect ,a/R `imq i' By:(t) /Date
1,1 Way Time
I Z.00 Received By: f fS7hipping Carrier:
Ticket No: Samples Received Cold? (Clrcl YES O
Temperature`C: 2),
Relinquished By: (2) Date T
ime Received By:
Special Deliverable Requirements:
Cha ody Seal: (Circle)
INTACT BROKEN ABSENT
Relinquished By. (3) Date Time R
i
d I
ece
ve
By:
Requested Turnaround Time and Sp
St'.c
ial
Relinquished By: (4) a`t O Time Recei d y: