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Chain of Custody and Analytical Request Record <br />mwm? PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 2 of 2 <br />Company Name: Cotter Corporation Project Name: Schwartzwelder <br />Tracking No. 3692013 00179421 Water Monitoring Program <br /> REF #/ DATE: 7/28/2010 <br />Report Mail Address: Contact Name: Kristy Usnich Sampler Name If other than Contact: <br />Canon City, MITI 1-719-275-7413 EX 213 Susan Wyman. Bob Tennant <br />PO Box 1750 81215-1750 <br />invoice Address: Invoice Contact & Phone #: Purchase Order M ELI Quote g <br />anon CKy MI Kristy Usniok 2W3 <br />PO. Box 1750 81215-1750 1-719-275.7413 EX 213 <br />Report Required For. P0TWNM7 ? OW Notify ELI prior to RUSH sample Rawl; <br />Other submittal for additional charges and 3 U <br />ort Formats - ELI must be notified prior to <br />ecial Re <br />S scheduling ler <br />p <br />p c Comments: <br />sample submittal for time following: m <br />NELAC ? A2LA ? Level IV ? <br />h <br />m3 <br />g <br />43 <br />Extended Mine Pool suite <br />er <br />Ot a Intact <br />EDD/EDT Format Signet <br /> W Table 1 Match <br />SAMPLE IDENTIFICATION Colbdbn Collection s EI <br />a <br />Name, Location, Interval, etc.) <br />1 Date Time <br />> <br />> <br />°? <br />a t <br /> MATRIX <br />SWAM 7128/2010 12:55 WATER 13 D 0 <br />SWW BPL 78812010 14:05 WATER ? t] ? D ® „ <br /> D o 0 0 0 <br />E <br /> ? 0 0 0 0 C1 d LI <br /> ? 0 0 0 0 [Eli d El Li <br /> O D D 0 O <br /> <br />0 <br />0 <br />0 <br />? <br />o Ej 14 C1 9 <br />. <br /> D O D O D <br /> ? 0 D ? ? <br /> ? ICI D ? ? 11 SHAFT-800FT 7=10 17:40 <br /> RwINuwwd W. Bob Tennant Date/Time: 712811 0-1 7:00 Shipped by. Received by:. Date/Time: <br />Custody <br />Record MUST <br />Relinquished W. Date/Time: <br />Shipped by: <br /> <br />Datefrime: <br />Received by. <br />be Signed Sample Disposal: Return to Client ? Lob Disposal ® Sam le Type LAIBORAT ORY fraUSE ctio $LY <br />?o <br />?o <br />N <br />O <br />N <br />co <br />rn certain ciraunsaepes, nmpla submhled to Enagy r eboratoda. inc. mny be wboa?trstxed to ether catitied hd,antoeiets in cider to complete the analysis regoeated. nh serve M notice of <br /> ibis posWity. All sub-contract data <br />wW be dearly notebd as your mmty&W resort.