2013-05-09_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 5/9/2013
• Doc Name: Surface Water Data for March 2013.
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• Media Type: D
• Archive: No

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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
Company Name: Cotter Corporation
Project Name: Schwartz -
Tracking No 3692013 62583709
DATE:3 /12/13 SSTF: S26819 & S26820
Report Mail Address:
Sampler Name if other than Contact
Cotter Corporation - Canon City Mill
Contact Name: Frank Adamic
1- 303-642 -3893 mine phone
PO Box 1750; Canon City, CO 81215 -1750
Voice: 1- 719 -275 -7413 ext. 204
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]
ANALYSIS
REQUESTED
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IDENTIFICATION
Collection
Collection
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Match 131D
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Date
Time
°
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MATRIX
1 SW -AWD
3112/13
9:00
Water 1
010,0
❑
❑
1 ❑
❑
❑
❑
❑
®
❑
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2 SW-BPL
3112113
9:30
Water 1
®
❑
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❑
O
❑
❑
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❑
®
❑
3
O
❑
❑
❑
❑
❑
❑
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❑
❑
❑
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tLS
4
❑
❑
❑
O
❑
O
❑
❑
❑
O
❑
❑
5
❑
1 ❑
❑
❑
❑
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10
[1
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6
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11—
7
❑
❑ 1
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❑
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O
❑
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O
8
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10
01010
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Custody
Relinquished by: Bob Tennant DatelTme:3/12/13 16:30
Shipped by: FedEx
Received by: DatelTime:
Record
Relinquished by: DateTme:
Shipped by:
Received b DatelTme: jrjam - i
MUST be
Signed
Sample Disposal: Return to Client El Lab Disposal ®
LAB TORY USE ONLY
Sam le T # of fractions