2011-04-08_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 4/8/2011
• Doc Name: Mar. 2011 SW Data- Pt.1
• 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 00180281 DATE: 3108;11 SSTF: 525677---525684
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 81216-1750 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 R ei Temp
Report Required For: POTW/WWTP ? RUSH sample , 0C
Other submittal for
additional charges C 04 ler ID(s)
Special Report Formats - ELI must be notified
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IDENTIFICATION Collection Collection N Match LAB ID
(Name, Location, Date Time j =
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Interval, etc MATRIX
SW AWD 3108/11 9:40 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
2 SW A001 3108111 9:55 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
3 SW BDIS 3108/11 10:00 Water ® ? ? ? ? ? ? ? ? ? ® ? Code I
4 SW PL 3/08111 11:25 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
5 Sw OS 3/08/11 11:35 Water ? ? ? ® ? ? ? ? ? ? ® ? Table 1
e SW BOS 3/08/11 13:35 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
' SW GS 3/08/11 13:45 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
e SW BPL 3/08/11 13:50 Water ? ? ? ? ? ? ? ? ? ? ® ? Code l
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Relinquished by: Bob Tennant Daterrime:3/08/11 Shipped by: Datelrime: 3 C.1 ? ?,?
Custody 16:00
Record
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Relinquished by: DatelTime:
Shipped by:
Received by: Datelrime: L >3
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Signed Sample Disposal: Return to Client ? Lab Disposal 0 Sam le TLABORATORY USE # of fractions