2010-12-13_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/13/2010
• Doc Name: October 2010 Surface Water Monitoring Data- Part 2
• From: Cotter
• To: CDPHE-WQCD
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• 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: Schwartzwaider Water Monitoring Program -
Tracking No. 3692013 00179803 DATE: _10/26/10 SSTF: S 25248---S25250 and S25376
Report Mail Address:
Cotter Corporation - Canon City Mill
Contact Name: Kristy Usnick Sampler Name if other than Contact:
1-303-642-3893 mine phone
PO Box 1750; Canon City, CO 81215-1750 Voice: 1-719-275-7413 ext. 213 Bob Tennant 1-719-371-3009-cell
Invoice Address:
PO Box 1750 Invoice Contact: Kristy Usnick Purchase Order #: ELI Quote #:
Tel: [phone] ext. 213
Canon City, CO 81215-1750 pax: 1-719-275-1669
Notify ELI prior to

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2 SW A001 10126/1 0 10:05 Water 00 D D D D D D E3 13 0 ? Code 1
a SW SDIS 10/26/10 11:15 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
a SW PL 1 ort6110 12:20 Water ? D D ® D ? O ? ? D ® ? Table 1
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Signed Sample Disposal: Return to Client ? Lab Disposal ® LABORATORY USE ONLY
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