Laserfiche WebLink
Chain of Custody 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.7707 2333 2135 DATE: 7/29/14 SSTF: S27512 <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 /> s�r�az. sRs€t�ca:.r_ rtu+� Notify ELI prior to <br /> Report Required For: POTW/WIIVrP❑ RUSH sample Receipt Temp <br /> Other submittal for C <br /> Special Report Formats-ELI must be notified ..of a additional charges Cogler ID(s) <br /> prior to sample submittal for the following: E. „; t and schedulin <br /> NELAC ❑ A2LA❑ Level IV❑ s �', s o g Comments: Custody-Sea[ <br /> Other ..8 a ci t E m S&A Schedule Code: Intact <br /> EDD/EDT❑ Formates o o c eo E Y/ <br /> z I✓ ! N W GW CODE: <br /> 6 s Signature <br /> SAMPLE N $ o C Y/,W- <br /> IDENTIFICATION Collection Collection �'� w v, N o z x F uen <br /> (Name, Location, Date Time o m Match LAB ID <br /> Interval,etc MATRIX '' ~ ~ a x ~ Y/�1-- <br /> 'Domestic Well 7/29/14 12:05 Water 8 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ Table 2 <br /> 2 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 3 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ LU <br /> 4 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ o <br /> 5 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 7 ii <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ CK <br /> TU <br /> 10 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> QQ <br /> N Custody Relinquished by: B Tennant Date/Tim7/30/14 16:30 Shipped by: FedEx Received by: DaterTime: <br /> o Record Relinquished by: Date/Time: Shipped by: Received by.'P-Q Date/Time:T I <br /> N MUST be LABORATORY USE ONLY <br /> Signed Sample Disposal: Return to Client El Lab Disposal® Sample T #of fractions <br />