2011-05-11_HYDROLOGY - M1977300 ‎(8)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/11/2011
• Doc Name: March 2011 SW Data- 3-8-11
• 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
AUM ' ' 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: Schwartz -
Tracking nio. 3692013 001 800281 DATE: _3108/11 SSTF: S25677---S25684
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 #: ELI Quote
PO Box 1750 Tel: [phone] ext. 209
Canon City, CO 81215-1750 Fax: [phone]
Notify ELI prior to Temp
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SAMPLE ? ? on Frequency 1, YIN
IDENTIFICATION Collection Collection Match LAB ID
(Name, Location,- Date Time > > N Y I N
Interval, etc) I MATRIX
SW AWD 3108/11 9:40 Water ® ? ? ? 1:1 ? ? ? ? ? ® ? Code 1
s SW A001 3108111 9:55 Water ® ? ? ? ? ? C3 ? ? ? ® ? Code 1 _
3 SW BDIS 3/08/11 10:00 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1

° SW PL 3/08111 11:25 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
5 SW OS 3/08111 11:35 Water ? ? ? ® ? ? ? ? ? ? ® [3 Table 1
6 SW BOS 3MB/11 13:35 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
SW GS 3108/11 13:45 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
e SW BPL 3108/11 13:50 Water ? ? ? ? ? ? ? ? ? ? ® ? Code 1
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Relinquished by: Bob Tennant Daterrime:3/08111
Shipped by:
AMVA'fy Date/Time: C,1
Custody 16:00
Record
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Relinquished by: Date/Time:
Shipped by:
Received by: Date(Time: l t?7
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Signed Sample Disposal: Return to Client ? Lab Disposal ® LABORATORY USE ONLY
Sample Type # of fractions