2011-05-11_HYDROLOGY - M1977300 ‎(9)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/11/2011
• Doc Name: March 2011 SW Data- 3-22-11
• 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
mm-WHIMM 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 61575934 DATE: _3122/11 SSTF: S25636---S25643
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 i
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Cooler ID(s)
Special Report Formats - ELI must be notified
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Comments:
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EDD/EDT [I Format < S&A Schedule Code : Intact
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Z SW CODE # 1
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SAMPLE
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Hequencyl 1 gnature
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IDENTIFICATION Collection Collection
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Two coolers
Match LAB ID
(Name, Location, Date Time
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Interval etc MATRIX ' u'
I SW AWD 3122/11 9:55 Water IS ? ? ? ? ? ? ? ? ? ® ? Code 1
2 SW A001 3/22/11 10:05 Water 01 0 ? ? ? ? ? ? ? ? ® ? Code 1
3 SW BDIS 3122/11 10:15 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
4 SW PL 3/22/11 11:30 Water ® D ? ? ? ? ? ? ? ? ® ? Code 1
s SW OS 3/22/11 11:40 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
6 SW BOS 3/22/11 11:50 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
' SW GS 3/22111 13:10 Water ? ? ? ® ? ? ? ? ? ? ® ? Table 1
a SW BPL 3/22/11 13:20 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
9 ? ? ? ? ? ? ? ? ? ? ? ? v1?
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Custody Relinquished by: Bob Tennant Date/Time:3/22/11 16:00 Shipped by: Received by:OIgl? Date/Time:
Record Relinquished by: Date(Time: Shipped by: Received by: Date/Time:
MUST b
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Signed
Sample Disposal: Return to Client ? Lab Disposal 0 LABORATORY USE ONLY
Sample Type # of fractions