2012-02-22_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 2/22/2012
• Doc Name: SURFACE & GROUNDWATER DATA FOR FOURTH QTR 2011, PART 1 OF 2
• From: COTTER
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

Company Name: Cotter Corporation
Tracking No. 3692013 61528640
Project Name: Schwartz -
DATE: 10/06/11 SSTF: S26029
Report Mail Address:
Cotter Corporation - Canon City Mill
PO Box 1750; Canon City, CO 81215 -1750
Contact Name: Randy Whicker
Voice: 1- 719 - 275 -7413 ext. 210
Sampler Name if other than Contact:
1- 303 -642 -3893 mine phone
Bob Tennant 1 -719- 371- 3009 -cell
Invoice Address:
PO Box 1750
Canon City, CO 81215 - 1750
Invoice Contact: JoAnne Ary
Tel: 1- 719 - 275 -7413 ext. 209
1-719-275-1669
Purchase Order #:
ELI Quote #:
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Report Required
Special Report
prior to sample
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Level
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s Schedule Code :
f3W CODE:
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Custody 5eal
Y tip:
Intact
Y / N
Signature
Y / N
Match LAB ID
Y / N
Other
EDD /EDT ❑ Format
SAMPLE
IDENTIFICATION
(Name, Location,
Interval, etc)
Collection
Date
Collection
lime
MW-00
10106/11
11:05
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Custody
Record
MUST be
Signed
Relinquished by: Bob Tennant Date/Time:10/7 /11 16 30
Shipped by: FedEx
Shi by:
Received by: Date/Time:
Receive bye' ( S St Date/Tim da Jb -i t' Z
Relinqu by: Date(Time:
Sample Disposal:
Return to Client ❑ Lab Disposal ®
LABORATORY USE ONLY
Sample Type # of fractions
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