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 2 of 3 <br />Company Name: Cotter Corporation Project Name: Schwartzwalder <br />Tracking No. 3692013 00179315 Water Monitoring Program <br /> REF bill DATE: 6MC010 <br />Report Mail Address: Contact Name: Kristy Usnick Sampler Name if other than Contact: <br />CANON CITY, MILL 1-719-275-7413 CEX 213 Bob Tennant <br />PO BOX 1750 81215-1750 <br />Invoice Address: Invoice Contact & Phone t. Purchase Order #: ELI Quote M. <br />CANON CITY, MILL Kristy Usnick 2563 <br />PO BOX 1750 81215-1750 1-719-275-7413 (SEX 213 <br />Report Required For. POTW/IMWTP ? DW Notify ELI prior to RUSH sample R <br />T?n!P <br />Other <br />Special Report Formats - ELI must be notified prior to <br />o <br />tr submittal for additional charges and <br />scheduli C <br />a C <br />CID(s) <br />sample submittal for the following JAW t Comments: (ail?L <br />N <br />C ? A2LA ? Level IV ? g Custody Seat' <br />r <br />EDD/EDT Format es < Intact Y N <br />Signature Y N <br /> z <br />SAMPLE IDENTIFICATION Collection Collection 1 y Meth l <br />(Name, Location, Interval, etc) Date Time MATRIX LAB 10 <br />AWD 619/10 8:33 WATER Species Name <br />A001 6/9/10 9:46 WATER Spades Name <br />SPL 6/9/10 13.00 WATER Species Name <br />FBRG 6/9/10 13:35 Water Spas Name <br />ARM 6/9/10 14:10 WATER 91 CJ 0 CJ C Species Name <br />LLHG 6/9/10 14:40 WATER 0 <br />14 r- <br />r <br /> <br />Sped" Name <br /> 11 r- d d r- 11 d <br />Species Name <br /> Species Name <br /> Species Name <br /> Species Name <br />Custody Relinquished by: Bob Tennant 6/9/2010 DatelTime:17:30 Shipped by: Received by: DatalTime: <br />Record MUST Relinquished by: Date/Time: Shipped b - Received by. DateMm . <br />be Signed <br />Sample Disposal: Return to Client ? Lab Disposal ® LABORATORY USE ONLY <br /> Sample Type # of fractions <br />In catain ciramstonom samples submitted to Emu Laboratories, Inc. may be subcontracted to fter c atifled laboratories is order to complete the analysis revested. This saves as notice <br /> or this possibility. All sob-comrw daft <br />wul boolowly n -M on your anolytioat sport.