2011-05-11_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/11/2011
• Doc Name: March 2011 SW Data- 3-29-11
• 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 61575958 DATE: _3129111 SSTF: S25663---525670
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

Report Required For: POTW/WVVrP ?
RUSH sample Receipt?T
Other
Special Report Formats -ELI must be notified
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1 SW AWD 3/29/11 10:05 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
2 SW A001 3129111 10:15 Water ® ? ? ? ? ? ? ? ? ? ® ? Cade 1
3 SW BDIS 3129/11 11:55 Water ® ? ? ? ? ? ? ? ? 11 ® ? Code 1
4 SW PL 3/29111 12:05 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
5 SW OS 3/29/11 12:10 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
6 SW BOS 3/29111 13:20 Water ® ? ? ? ? ? ? ? ? ? ® ? Cade I
' SW GS 3129111 13:30 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
a SW BPL 3129/11 13:40 Water ® ? ? ? ? ? 0 10 ? ? ® ? Code 1
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Custody Relinquished by: Bob Tennant Date/Time:3129/11 16:00 Shipped by: Receiv Da e i e:
Record Relinquished by: Date/Time: Shipped by: Received by: Qate/Time: ,?D,y j y
MUST be
Signed
Sample Disposal: Return to Client ? Lab Disposal ® LABORATORY USE ONLY
Sample Tyne # of fractions