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Chain of Custody & Analytical Request Record <br /> www energylab coin 1 <br /> Page l of � <br /> Account Information leruing,nfo manes' Report Information fit different than Account Information) Comments <br /> Company/Name t11Cr Company/Name <br /> Contact -� �A- V' `/l..N Q <br /> r Contact J <br /> Phone �0� - ' L Phone �/1 <br /> Ma,hng Address a'� Mailing Address - /`�� <br /> City,State Zip - Cat, Stale Zip <br /> Email ` t <br /> u Email <br /> Receive Invoice ''Hard Copy 'Email Receive Report Hard Copy Email Receive Report Hand Copv I Emad <br /> Purchase Order Quote Bottle Order -11-1 ReporY�u,mats - -- <br /> 5881 75593 LEVEL IV NELAC EDD EDT it •rca iahorarn yi 011ie, <br /> Project Information Matrix codes Analysis Requested <br /> Project Name PWSiD Permit,etc Sr 1 ^ ^i' All turnaround times are <br /> �t'l ;n "l '� ��'VcVi <br /> Sampler Name =,�-t i.L.�ll t Sampler Phone t� C wale, _ standard unless marked as <br /> fl 3) -A J s sc,s � RUSH <br /> Sample Ongm State s°'d5 x7 Energy Laboratories <br /> C,u�O�.�],V EP0.-Slate Compliance Yes No J <br /> in URANIUM MINING CLIENTS MUST Indicate sample type a MUST be contacted prior to Unprocessed Ore en,assay t RUSH sample submittal for <br /> 0 charges and scheduling- <br /> Processed Ore IGround or _annedl"CALL BEI ORE SENDING o See Instructions Page <br /> _ roduct Material Gan ONLY be Subm_itteo to ELI Cas r Location Dw � <br /> Sample Identification ____ Collectioname ,r„�,,, Matrix I_ m ELI LAB ID <br /> (h L-.0—mrerva/err, Date. Time C'nma•ne•� :.•. N pegN <br /> TAT Laboratory Um Only <br /> z <br /> j � <br /> 3 <br /> 4 <br /> 7 <br /> 8 <br /> ELI is REQUIRED to provide preservative traceability. If the preservatives supplied with the bottle order were NOT used please attach your preservative Information with this COC <br /> Custody Relirpu�sbeo by ipnm; Dale'Timr sgaal a Reco,erl by ipr nti Date Timr Ciyr'tiur9 Record ZV _ �� �.•i-�3_p <br /> MUST Reeni„nsnra ny ipnnu I c.rtr ,me sweat„re • wo-er 4a' ate y,vrin _ l be signed , <br /> It <br /> re <br /> IASORATORY USE Y <br /> Shipped By Cooler 101s) Custody Seals Intact Receipt Temp Temp Blank On Ice Payment Type Amount Receipt Number rcahirheck nnfp Y N C B Y N 'C s CC Cash Check $ <br /> In certain circumstances samples submitted to Energy Laboratories,Inc may be subcontracted to other certified laboratories in order to complete the analysis requested <br /> CD This serves as notice of this possibility All subcontracted data will be clearly notated on your analytical report <br /> fV <br /> O <br /> O <br /> tU <br /> r I I C OC 01121 v 4 <br /> O <br />