2013-08-06_HYDROLOGY - M1977300 ‎(3)‎

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 8/6/2013
• Doc Name: Surface Water Data for May 2013- 3.
• 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: Schwarz -
Tracking No 3692013 61723663
DATE:5122/13 SSTF: S26997 TH S26998
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: 1- 719 - 275 -1669
Notify ELI prior to
Receipt Temp
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Custody
Relinquished by: Bob Tennant Daterrime:4/22/13 16:30
Shipped by: FedEx
Received by: Date/Time:
Record
Relinquished by: Date/Time:
Shipped by:
Received by: Daterrime�.xy.1g T.
MUST be
Signed
Sample Disposal: Return to Client El Lab Disposal ®
LAB ORY USE ONLY
Sam le Tv-- # of fractions