Laserfiche WebLink
Chain of Custody and Analytical Request Record <br /> MMMINEW 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.7704 2253 5823 DATE:6/25/14 SSTF: S27546, S27547 <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-cell <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 /> Notify ELI prior to <br /> Report Required For: POTW/WVVTP❑ RUSH sample ReceiptTemp <br /> Other submittal for t—�--- <br /> Special Report Formats—ELI must be notified ..o a additional charges Cooler ID(s) <br /> prior to sample submittal for the following: A P M. g t, and schedulin Custod eal <br /> NELAC❑ A2LA❑ Level IV❑ a > g Comments: Y <br /> Other a s t 2 Intact <br /> EDD/EDT❑ Format c �, F E S&A Schedule Code: <br /> z t t N t'- GW CODE: Y/#— <br /> SAMPLE N y Signature <br /> YLN <br /> IDENTIFICATION Collection Collection � n Z � F uen Match B ID <br /> (Name, Location, o ,b ,� Y/�bl— <br /> Interval, etc MATRIX ~ ~ a � 9 <br /> 'MW-6 6/25/14 11:15 Water 6 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ Table 2 � <br /> 2 MW-7 6/25114 13:15 Water 6 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ <br /> s ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ "lA <br /> 5 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ C1 <br /> s.rF' <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ tom: <br /> til- <br /> v <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ a 10 ❑ ❑ <br /> N <br /> o Custody Relinquished by: Tennant Daterrim6/25/14 16:30 Shi ed by: FedEx Received by: Date/Time: <br /> w Record Relinquished by: Date/Time: Shipped by: Received by: Date/Time:La ate <br /> MUST be LABORATORY USE ONLY <br /> Signed Sample Disposal: Return to Client❑ Lab Disposal® Sample Type #of fractions <br />