2013-11-26_HYDROLOGY - M1977300 (5)

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v CD h W ,*-Am" LIOLVUy dnv Amytical 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 808812015000180 DATE:9/10113 SSTF: ,S27153 to S27156 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 Report Required For: POTWNWVTP ❑ ANALYSIS R! Ok-Z -5 = EO Notify ELI prior to RUSH sample Rece' t Temp Other $ F submittal for -C Cooler I Special Report Formats — ELI must be notified .. G a addrtional charges (s prior to sample submittal for the following: po-� � t and schedulin Custod��l Comments: N�rC ❑ A2LA ❑ Level IV ❑ > EDD /EDT ❑ Format 142 -ca 9 E g E' S&A Schedule Code: Intact / N I — .. i Table 1 Frequency) 1, Signature Y / N SAMPLE IDENTIFICATION ColWc ion Location, Collection Ir Match LAB ID (Name, Y / N Interval etc MATRIX ~ I SW-AWD 9/10113 11:05 Water 1 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ 2 SW -BPL 9/10/13 11:30 Water 1 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ 3 SW -F8RG 9 -10-13 12:00 Water 3 ❑ ® ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ 4 SW ARH 9 -10 -13 12:15 Water 3 ❑ ® ® ❑ ❑ ❑ ® ❑ 5 ❑ ❑ ❑ ❑ El ❑ ❑ ❑ ❑ ❑ ❑ s O ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11-- 7 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ -1-31 tac 8 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Ca 9 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ - 10 ❑ ❑ ❑ ❑ ❑ ❑ ❑ A ❑ ❑ ❑ 1 ❑ ❑ Custody Relinquished by: Bob Tennant Date/Time:9 /10/13 16:30 Shipped by: FedEx Received by: DatetTime: Record Relinquished by: Daterrime: Shipped by: Received by: 4% Date/Time: MUST be Signed to Client ❑ Lab Disposal Sample Disposal: Return to LABORATORY USE ONLY e T # of fractions Sample