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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 2 <br />Company Name: Cotter Corporation Project Name: Schwartzwalder <br />Tracking No. 3692013 00179483 Water Monitoring Program <br /> REF #/ DATE: 8/10/2010 <br />Report Mail Address: Contact Name: Kristy Usnick Sampler Name if other than Contact: <br />Canon City, Mill 1-719-275-7413 EX 213 Bob Tennant <br />PO Box 1750 81215-1750 <br />Invoice Address: Invoice Contact & Phone Purchase Order* ELI Quote #: <br />Canon City Mill Kristy Usnick 2563 <br />PO. Box 1750 81215-1750 1-719-275-7413 EX 213 <br />Report Required For: POTWNVWTP ? DW ? Notify ELI prior to RUSH sample i <br /> <br />Other <br />S <br />i <br />lA d <br />2 <br />8 <br />submittal for additional charges an e <br />p <br />pec <br />al Report Formats - ELI must be notified prior to 1 <br />- 0 c < schedulin l <br />C <br /> <br />sample submittal for the following: <br />NELAC ? A21LA ? L <br />l IV ? <br />? m • <br />> ? <br />_ <br />t <br />Comments: oo <br />er <br />?9f <br />eve ,s d <br />8 a 2 limited Custoc <br />Other <br />EDD/EDT Format a elm' <br />a <br />a F <br />g 9 extended <br />uranium (total 8 potentially Intact <br /> Z : a = dissolved) Match I <br />SAMPLE IDENTIFICATION Collection Collection alp to N <br />N <br />N C j radium 226+228 (total) <br />(Name, Location, Interval, etc) Date Time o <br />> y <br />> vj <br />L <br /> MATRIX ` <br />1 Dis 001A 8/10110 Shr composite water 13 13 13 11 Stop at 13:45 <br />2 <br />? <br />? <br />? <br />? <br />? <br />Species Name <br />3 ? ? ? ? ? E: E: C: C: E: Ll Ll Species Name <br />4 ? ? ? ? ? 1: C: 9 9 Species Name <br />5 ? ? ? ? ? C: C: r -C R Species Name <br />6 ? ? ? ? ? c: r- c: F- q -9 Iq Species Name <br />7 ? ? ? ? ? 1: C c: [ ft: 9 Species Name <br />e ? ? ? ? ? Species Name <br />s ? ? ? ? ? E: 1: Species Name <br />,o ? ? ? ? [I <br />P Species Name Oo <br /> Relinquished by: Bob Tennant Date/Time: 8/10110- 17:00 Shipped by: ceiyqA <br />by <br />Date/Time: <br />Custod - <br />.- <br />y <br />Record MUST Relinquished by: Date/Time: Shipped by: R eived <br />be Signed <br />Sample Disposal: Return to Client ? Lab Dispos <br />al ® ORATORY USE ONLY <br /> S m e # of fractions <br />v <br />ca <br />CD <br />0 <br />co <br />In certain circumstances, samples submitted to Energy Laboratories, Inc. may be subcontracted to other certified laboratories in order to complete the analysis requested. This serves <br /> as notice of this possibility. All sub-contract data <br />will be clearly notated on your analytical report.