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CD <br />0) <br />0 <br />co <br />r::::-A <br />Chain of Custody and Analyticsl Request <br />PLEASE PRINT; provide as much information as possible. Reftar to corresponding <br />notes on reverse side. Page 1 of 1 <br />Company Name: Cotter Corporation <br />Project Name: Schwartz - <br />Tracking No 45931688 6383 <br />DATE:? 119/13 SSTF: ,S27049 & S27050 <br />Report Mail Address: <br />Sampler Name if other than Contact: <br />Cotter Corporation - Canon City Mill <br />Contact Name: Frank Adamic <br />1- 303 - 642 -3893 mine phone <br />PO Box 1750; Canon City, CO 81215 -1750 <br />Voice: 1 -719- 275 -7413 ext. 204 <br />Bob Tennant 1- 719- 371- 3009 -Cell <br />Invoice Address: <br />Invoice Contact: JoAnne Ary <br />Purchase Order #: <br />ELI Quote #: <br />PO Box 1750 <br />Tel: 1- 719 -275 -7413 ext. 209 <br />Canon City, CO 81215 -1750 <br />Fax: 1 -719- 275 -1669 <br />Report Required For. POTWNVWTP ❑ <br />ANA' <br />r Sts <br />aEOUESTEC <br />Notify ELI prior to <br />RUSH sample <br />Re zrpc <br />Other <br />rm <br />Special Report Formats – ELI must be notified <br />to sample submittal for the following: <br />.. a <br />submittal for <br />l additional charges <br />Cooler (s <br />prior <br />NELAC ❑ A2LA ❑ Level IV ❑ <br />�, <br />u <br />t and scheduling <br />Comments: <br />I <br />Other <br />Z <br />$ <br />2 <br />^�f <br />Y'W <br />EDD/EDT ❑ Format <br />` <br />s' <br />E S&A Schedule Code: <br />I� <br />N <br />!s <br />– <br />g SW CODE I 1 <br />Table # <br />Frequency) 1, <br />'l Y/ <br />Sig re <br />/QC.I' N <br />SAMPLE <br />IDENTIFICATION <br />(Name, Location, <br />Collection <br />Date <br />Collection <br />lectfon <br />Time <br />° <br />� <br />Mat,�ta, LB <br />ID <br />(� <br />—Interval, etc <br />MATRIX <br />SW AWD <br />7/19/13 <br />12:06 <br />Water 1 <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />® <br />❑ <br />} <br />2 SW -BPL <br />7/19113 <br />12:35 <br />Water 1 <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />® <br />❑ <br />3 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />LU <br />4 <br />❑ <br />131010 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />& <br />5 <br />❑ <br />❑ jo <br />❑ <br />❑ <br />I ❑ <br />❑ <br />I ❑ <br />❑❑ <br />❑ <br />❑ <br />6 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />C) <br />7 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />10 <br />❑ <br />❑ <br />❑ <br />❑ <br />ra_ <br />$ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />CDP <br />cn <br />a <br />❑ <br />01010 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />... <br />+o <br />❑ <br />O <br />❑ <br />❑ <br />❑ <br />El <br />El <br />❑ <br />❑ <br />❑ <br />❑ <br />Custody <br />ReinquishW by: Bob Tennant DaWrime:7 /19/ 13 16:30 <br />Shipped by: FedEx <br />Received by: DataMme.7 <br />Record <br />Relinquished by: Daterrime: <br />Shipped by: <br />Received b Date; ime: .4(� <br />MUST be <br />. <br />Signed <br />Sample Disposal: Return to Client ❑ Lab Disposal <br />LABORATORY USE ONLY <br />Sam Type # of fractions <br />