2011-01-12_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/12/2011
• Doc Name: November 2010 Surface Water Monitoring Data- 1.
• From: Cotter
• To: CDPHE- WQCD
• Permit Index Doc Type: Hydrology Report
• Email Name: DB2
• 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
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Company Name: Cotter Corporation Project Name: Schwartmaider Water Monitoring Program -
Tracking No. 3692013 00179872 DATE: _11110/10 SSTF: S 25387---S25394
Report Mail Address: Sampler Name if other than Contact:
Cotter Corporation - Canon City Mill Contact Name: Kristy Usnick 1-303-642-3893 mine phone
PO Box 1750; Canon City, CO 81215-1750 Voice: 1-719-275-7413 ext. 213 Bob Tennant 1-719-371-3909-cell
Invoice Address: Invoice Contact: Kristy Usnick Purchase Order #: ELI Quote
PO Box 1750 Tel: [phone] ext. 213
Canon City, CO 81215-1750 Fax: [phone]
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IDENTIFICATION Collection Collection ?m a N a z requency( 1,2,3,4 Y/ N
(Name, Location, Date Time 7 ro ,, Match LAB ID
Interval etc MATRIX > > c " N Y I N
' SW AM 11/09110 9:25 Water ® ? ? ? ? ? ? ? ? O ® ? Codel
2 SW A001 11109/10 9:52 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
3 SW BDIS 11/09/10 11:16 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
< SW PL 11/09/10 11:22 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
5 SW OS 11109/10 13:12 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
6 SW BOS 11/09/10 13:25 Water ? ? ? ® ? ? ? ? ? ? ® ? Table 1
SW GS 11/09/10 14:55 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
e SW BPL 11/09/10 15:03 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
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Custody Relinquished by: Bob Tennant Date/Time:11110/10
16:30
Shipped by:
Received by: DatelTime: tj /
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MUSTrbe Relinquished by: Daterrime: Shipped by: Received by: Date/Time:
Signed Sample Disposal: Return to Client ? Lab Disposal ® LABORATORY USE ONLY
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