2013-06-05_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 6/5/2013
• Doc Name: Surface Water Data for April 2013.
• From: Cotter
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Email Name: TAK
• 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
Company Name: Cotter Corporation
Project Name: Schwartz -
Tracking No 3692013 61723397
DATER 123/13 SSTF: S26893 & S26894
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: 1- 719 - 275 -7413 ext. 209
Canon City, CO 81215 -1750
Fax: [phone]
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Custody
Relinquished by: Bob Tennant DatefTimeA/25 /13 Wo;3017
hipped by: FedEx
Received by: Date/Tme+ q,a
Record
MUST be
Received by:q Date/rime:
Relinquished by: Datefrime:
Shipped by:
Signed
Sample Disposal: Return to Client ❑ Lab Disposal ®
LABORATORY USE ONLY
sample Type # of fractions