2013-11-26_HYDROLOGY - M1977300 (4)

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T CD v CD AurChain 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. 8088120 15000296 DATE: 9/24/13 SSTF: S27176&S27 1 77 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: POTWNVWTP El ANALYSIS REQUESTED Notify ELI prior to RUSH sample R F pC o Other Special Report Formats — ELI must be notified to submittal for the following: g .. tm a submittal for p additional charges G and scheduling ter ID(s prior sample ~' _ ° Comments: ustody S I NELAC E] A2LA [I Level IV ❑ �3 E Y Other EDD /EDT [] Format S&A Schedule Code: Intact Z _ GW CODE: Y / Signature Y/N SAMPLE IDENTIFICATION Collection Collection 01 Fre uenc : Match LAB ID (Name, Location, Date Time Y / N Interval, etc ) MATRIX MW -17 9 -24-13 1240 Water 6 ® ❑ ❑ ❑ ❑ ❑ O © ❑ ❑ ® ❑ ?� Y MW -18 9 -24-13 1410 Water 6 ® ❑ ❑ ❑ ❑ ❑ ❑ I ❑ I ❑ ❑ ® ro 3 ❑ ❑ ❑ ❑ a ❑ ❑ 010'0 ❑ ❑ us 4 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ S 010,0 O O ❑ O D ❑ ❑ ❑ ❑ e ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ f-- 7 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ e ❑ ❑ Ci ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ co s ❑ ❑ ❑ 01010 ❑ ❑ ❑ ❑ ❑ ON 10 ❑ [:]10 ❑ O ❑ O ❑ ❑ ❑ ❑ ❑ Custody Reli ished by: Bob nn nt DatefTime:9/24 /13 16:30 1 Shipped by: FedEx Received b : DatefTime: Record Relinquished by: Date/Time: I Shipped by: Received by Dateffime: MUST be Signed Sample Disposal: Return to Client ❑ Lab Disposal ® LAB TORY USE ONLY Sam le Type of fractions 21�