2011-03-03_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 3/3/2011
• Doc Name: Jan. 2011 SW Data- Pt. 2
• 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: Schwartzwaider Water Monitoring Program -
Tracking No. 3692013 00180113 DATE: _1/25/11 SSTF: S25523-S25525 & S25568 TO S25572
Report Mail Address: Sampler Name if other than Contact:
Cotter Corporation - Canon City Mill Contact Name: Kristy Usnick 1-303-642-3893 mine phone
PO Box 1750; Canon City, CO 81215-1750 Voice: 1-719-275-7413 ext. 213 Bob Tennant 1-719-371-3009-cell
Invoice Address: Invoice Contact: Kristy Usnick Purchase Order ELI Quote
PO Box 1750 Tel: [phone] ext. 213
Canon City, CO 81215-1750 Fax: [phone]
Notify ELI prior to

Report Required For: POTWNVW P ?
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Frequency
Signature
Y / N
IDENTIFICATION Collection Collection a c Match LAB ID
(Name, Location, Date Time

Interval etc
MATRIX a Y / N
I SW AWD 1/25/11 10:30 Water ® ? ? © ? ? ? ? ? ? ® ? Code 1
2 SW A001 1/25/11 11:00 Water D ? ? ® ? D ? ? ? D ® ? Table 1
3 SW BDIS 1125/11 13:00 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
4 SW PL 1/25/11 13:10 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
s SW 08 1/25/11 13:20 Water ® O El ? ? ? ? D D ? ® ? Code 1
e SW BOS 1125/11 14:35 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1
SW GS 1125111 14:45 Water ® ? ? 11 ? ? ? ? ? ? ® ? Code 1
e SW SPL 1/25111 14:55 Water 0 10 ? D ? ? ? ? ? ? ® D Code 1
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Custody Relinquished by: Bob Tennant Date/Time:1/25/11 Shi d b
ppe y: J?A -
Received ?bt Dat ime:
17:30
Recoid
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Relinquished by: Daterrime:
Shipped by:
Received by: Date(Time:
Signed Sample Disposal: Return to Client 13 Lab Disposal ® LABORATORY USE ONLY
Sample T # of fractions
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