2011-05-11_HYDROLOGY - M1977300 ‎(5)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/11/2011
• Doc Name: March 2011 SW Data- 3-10-11
• From: Cotter
• To: DRMS
• 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: Schwartz -
Tracking No. 3692013 DATE: _3110111 SSTF: S25686--- S25688
Report Mail Address: Sampler Name if other than Contact:
Cotter Corporation - Canon City Mill Contact Name: Randy Whicker 1-303-642-3893 mine phone
PO Box 1750; Canon City, CO 81215-1750 Voice: 1-719-275-7413 ext. 210 Bob Tennant 1-719-371-3009-cell
Invoice Address: Invoice Contact: JoAnne Ary Purchase Order A ELI Quote
PO Box 1750 Tel: [phone] ext. 209
Canon City, CO 81215-1750 Fax: [phone]
Notify ELI prior to

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Y/N
IDENTIFICATION Collection Collection Match
LAB ID
(Name, Location, Date Time
Y / N
Interval etc MATRIX
I SW FBRG 3110111 9:05 Water ? ® 0 ? ? ? ? ? ? ? 0 ? Code 3
2 SW ARH 3/10/11 9:20 Water ? 0 ® ? ? ? ? ? ? ? ® ? Code 3
3 SW LLHG 3/10/11 9:40 Water ? ? ? 0 ? ? ? ? ? ? N ? Table I
4 ? ? ? ? ? ? ? ? ? ? ? ?
5 ? ? ? ? ? ? ? ? ? ? D ?
6 ? ? a ? ? ? ? ? ? ? ? ?
7 ? ? ? 0 ? ? ? ? ? ? ? ?
8 ? ? ? ? ? ? ? ? ? a ?
a ? ? ? ? ? ? ? ? ? o ?
,o ? ? 'n ? ? ? ? ? ? b ?
Custody Relinquished by: Bob Tennant Date/Time:3/10111 15:30 Shipped by: 7-0,I F'k/ Received b : a e ime: p/ /U 4 .il
Record ad by: Date/Time:
Relinquished by: Daterrime: Shipped by
:
MUST be
Signed _
.
LABORATORY USE ONLY
Sample Disposal: Return to Client ? Lat le Type 0 of fractions