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Chain of Custody & Analytical Request Record <br /> Trim bu,Peo*Tmsi ew Wo www.energvlab.com Page of <br /> Account Information(elNing information) Report Information(i/dMarant than Account Information) Comments <br /> Company/Name o aft- —'Ae_1S CompanytName (� <br /> Contact KCA � --_- Conrad \ ` \ O�T <br /> Phone �. Phone r\\J\ �1A \ <br /> Mailing Address U n RI Mailing Address <br /> City State.Zipveva d c� City.State,Zip OLD <br /> Email Email <br /> Receive Invoice LMard Copy ❑Email Receive Report 7Hard Copy f_lEmall Receive Report L7Hard Copy I]Email <br /> Purchase Order Quote Bottle Order 1 special Reporl/Formats <br /> 5881 lobdw -74A:7511 <br /> LJ LEVEL IV nNELAC (-1 EDD/EDT(contact raboratory)11 Other <br /> Project Information Matrix codes Anal fsls Requested <br /> Project Name.PWSID,Permit,etc W r A- A,, �� p m All turnaround times are <br /> ��---- standard unless marked as <br /> Sampler Name, r fi ` ' r Sampler Phone y 3 j_(^I (7 I w' Water --r <br /> W+ t s. soils/ G �� RUSH <br /> sonde Energy Laboratories <br /> Semple Origin StateC,)'b r AAA EPAtState Compliance n Yes r l No v v.a.eii MUST be contacted prior to <br /> URANIUM MINING CLIENTS MUST Indicate sample type a 9,oaaaay 1 m RUSH sample submittal for <br /> D Unprocessed Ore o- oil `_ PPP u charges and scheduling- <br /> Processed Ore(Ground or Refined)"CALL BEFORE SENDING ,- or.r,� QV. See Instructions Page <br /> 1 i t e 2"product <br /> rodtrd Material Can ONLY be Submitted to ELI Ces r Location W"O' r7C 31 <br /> Q <br /> Sample Identification -__Collection Numb.,er Matrix <br /> (/vama Locarbn,rnterva/arc) Date Time �'e"iea1e'a /_c' RUM" <br /> Ell t.A$ID <br /> TAT tebm+N+ydMCary <br /> _5Frioci 745 13 ,?- w ✓ 2 30 70ol G <br /> 2 FN S , ( ✓ <br /> 5 % 7 a5 a� ✓ <br /> / <br /> B <br /> s - I <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 !SaUquiah ,by i) D Rama $iipWif• - <br /> Racerd • S- ^ �� Received by(pnnn DeteT,,.,e Signature <br /> MUST Rax,quism,e by(print) t Dffie/rlme sgnalum Wed br Ls (pa" - D ins 6 <br /> be alerted <br /> YMOM <br /> Stopped ey Cooler ID(s) Custody Seals Intact Receipt Temp Temp 81ank On Ice Payment Type Amount Receipt Number(ceaNCMd eriN) <br /> a Y N C B Y N "C Y N Y N CC Cash Check _ $ <br /> N <br /> co <br /> fD <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 /> This serves as nottoe of this possibility All subcontracted data will be clearly rotated on your analytical report <br /> 0 <br /> w <br /> rn <br /> CLI-COGOl/Zl v 4 <br />