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ustody and Analytical Request Reco d corresponding notes on reverse side. Page 1011 <br /> CPLEASE PRINT; provide as much information a possible. <br /> Company Name: COttE'.f COrPOrat1011 <br /> Project Name: Schwartz - <br /> Tracking No 7704 0754 1943 DATE:6123I14 SSTF: $27542 TH S27543 Sampler Name if other than Contact: <br /> 1-303-642-3893 mine phone <br /> Report Mail Address: Contact Name: Frank Adamic Bob Tennant 1-719-371-3009-cell <br /> Cotter Corporation-Canon City Mill Voice: 1-719-275-7413 ext. 204 <br /> Purchase Order#: ELL Quote <br /> ktO <br /> ox 1750; Canon City, CO 81215-1750 Invoice Contact: JoAnne Ary <br /> Invoice Address: Tel: 1-719-275-7413 ext. 209 <br /> ox 1750 Notify ELI Prior to Receipt Temp <br /> Canon City, CO 81215-1750 Fax: 1-719-275-1669 <br /> 5o�a5-°>Y``' RUSH sampte LOAD °C <br /> POTWNVW P submittal for Cooler—ID(s) <br /> Report Required For: $ < F additional charges �ustody <br /> Other and schedulin <br /> Special Report Formats-ELI must be notified 80�i ;c o ° ; Comments: Y I�j <br /> prior to sample submittal for the following' > n $ j j ° <br /> 0 Q Intact <br /> NELAC❑ A2LA❑ Level N❑ a `o a Q S&A Schedule Code: Y/rN_ <br /> Other E a z - � SW CODE�1 Signature <br /> I 0i o z Table 1 <br /> EDDIEDT❑Format Z 4 Y 1� <br /> i; z Frequency 1, Match LAB ID <br /> SAMPLE Y 1-m— <br /> i IDENTIFICATION Coiiedion Collection aims10 <br /> o w <br /> Time r <br /> � (Name, Location, Date MATRIX � � m <br /> ' Interval, etc p O ❑ ❑ ❑ ❑ ® ° <br /> ' sw Awo 6123114 12:30 Water 1 ® ❑ ❑ ❑ <br /> 2 SW BPL 6123114 13:15 Water 1 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ _ �_ <br /> 3 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ y . <br /> ❑ ❑ ❑ Li Z <br /> 4 <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ° ° ❑ ❑ <br /> 9 ❑ ❑ ❑ ° ° DatelTime- <br /> 10 FedEx Received by: <br /> Shipped by: Daterfime:tvCD as 1 I <br /> Relinquished by: Bob T, ennant DatelTime:6124/14 16:30 Shipp Received by: <br /> o Custody Date!I ime: Shipped by: LABORATORY USE ONLY <br /> °' Record Relinquished by: #of fractions <br /> MUST be Return to Client❑ Lab Disposal® Sam le T <br /> Signed Sample Disposal: <br />