2013-08-06_HYDROLOGY - M1977300 ‎(2)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 8/6/2013
• Doc Name: Surface Water Data for May 2013- 2.
• 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 61723700
DATE:5 /16/13 SSTF: S26980
Report Mail Address:
Sampler Nime if other than Contact:
Cotter Corporation - Canon City Mill
Contact Name: Frank Adamic
1- 303842 -3693 mine phone
PO Box 1750; Canon City, CO 81215 -1750
Voice: 1- 719 -275 -7413 ext. 204
Bob T"nant 11719- 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]
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Custody
Relinquished by: Bob Tennant DatefT-ime:5 /16113 16:30
Shipped by: FedEx
Received by: DatelTime:
Record
Relinquished by: Date/Time:
Shipped by:
Received by: Date/Time: 511-1 j
MUST
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Signed
Sample Disposal: Return to Client ❑ Lab Disposal ®
LABORATORY USE ONLY
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