2011-01-12_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 1/12/2011
• Doc Name: November 2010 Surface Water Monitoring Data- 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: Schwartzwalder Water Monitoring Program -
Tracking No. 3692013 00179896 DATE: -11/17/10 SSTF: S 25426---S25433
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 1-719-371-3009-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]
Notify ELI prior to

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Custod Relinquished by: Bob Tennant Date/Time:11/17/10 Shipped b
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Signed Sample Disposal: Retum to Client ? Lab Disposal ® LABORATORY USE ONLY
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