Laserfiche WebLink
C ustody and Analytical Request Record <br /> PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 1 of 1 <br /> Company Name: Cotter Corporation Project Name: Schwartz - <br /> Tracking No 7987 2369 3470 DATE:5/01/14 SSTF: S27466 <br /> Report Mail Address: Sampler Name if other than Contact: <br /> Cotter Corporation-Canon City Mill Contact Name: Frank Adamic 1-303-642-3893 mine phone <br /> PO Box 1750; Canon City, CO 81215-1750 Voice: 1-719-275-7413 ext. 204 Bob Tennant 1-719-371-3009-ce11 <br /> Invoice Address: Invoice Contact: JoAnne Ary Purchase Order*: ELI Quote#: <br /> PO Box 1750 Tel: 1-719-275-7413 ext. 209 <br /> Canon City, CO 81215-1750 Fax: 1-719-275-1669 <br /> A i L's':st_w R Q �51>::r Notify ELI prior to <br /> Report Required For: POTW/WIIIfrP❑ € RUSH sample Rec7pl t T mp <br /> Other 9 submittal for C <br /> Special Report Formats—ELI must be notified ..o F additional charges Coder ID <br /> prior to sample submittal for the following: m w o a and schedufin <br /> Custody I <br /> NELAC ❑ A2LA❑ Level IV❑ g a� o ° e g Comments: Y y <br /> Other E 3 ;a v y <br /> EDD/EDT❑ Format E`�ai o E l S8�A Schedule Code: IntacY I N <br /> z c SW CODE 11 <br /> SAMPLE o o N Table 1 Signature <br /> IDENTIFICATION Collection Collection a' z Frequency 1, Y/N <br /> (Name, Location, Date Time a Match LAB ID <br /> Interval, etc) MATRIX > > '' Y/N <br /> ' SW-AWD 5/01/14 10:30 Water 7 ❑ ❑ ❑ ® ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ y <br /> 2 ❑ ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ❑ ❑ ` <br /> ram_ <br /> 3 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 4 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ LAOS <br /> 5 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 7 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 8 ❑ ❑ ❑ ❑ ❑ ❑ 01 ❑ ❑ ❑ ❑ ❑ <br /> B ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ � <br /> ,fl ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ <br /> CD <br /> ( Custody Relinquished by: Bob Tennant Datefrime:5/01/14 16:30 Shipped by: Fed Ex Received by: Datefrime: <br /> rQ <br /> MU�rbe Relinquished by: Date/Time: _ Shipped by: Received by: atefrime: <br /> Signed Sample Disposal: Return to Client❑ Lab Disposal® LABOR WY_USE O Y <br /> __ Sam le Ty #of fractions <br />