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WNW <br />Chain <br />r 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. 3682843- 08.. Water Monitoring Program <br /> y.21.3 602S" 72 <br /> REF #/ DATE: 8/19/2010 <br /> Report Mail Address: <br />Canon City <br />Mill Contact Name: Kristy Usnick Sampler Name if other than Contact: <br /> , <br />PO Box 1750 81215-1750 1-719-275-7413 EX 213 Bob Tennant <br /> Invoice Address: <br />Canon City Mill Invoice Contact & Phone Purchase Order #: ELI Quote <br /> <br />PO. Box 1750 81215-1750 Kristy Usnick 2563 <br /> 1-719-275-7413 EX 213 <br /> Report Required For: POTwwffrp ? Dw Notify ELI prior to RUSH sample <br /> <br />Other <br />Special Report Formats - ELI must be notified prior to <br /> <br />.. <br />y <br />F <br />< <br />submittal for additional charges and <br />F schedulin Rec ip <br />a <br />-- <br /> le <br />sam <br />b <br />itt <br />l f <br />h <br />f o <br />s ° <br /> p <br />su <br />m <br />a <br />or t <br />e <br />ollowing: m <br />~ w t Comments: Cooler <br /> NELAC ? A2LA ? Level IV ? y <br />'6 <br />>? limited 35/ <br /> <br />Other <br />EDD/EDT Format <br />< & <br />a <br />W <br /> <br />r <br />?, <br />< <br />E <br /> <br />2 <br /> <br />E <br />extend <br /> <br />15 d <br />t <br />d Custod <br />Intact <br /> <br />Intact <br /> <br />Z H 1 ? ay <br />urn aroun Signatt <br /> SAMPLE IDENTIFICATION <br />(Name <br />Location <br />Interval <br />t Collection <br />D <br />t Collection <br />T ?iN <br />o y <br />N <br />,v <br />vi d <br />z y Match <br /> , <br />, <br />, e <br />c) a <br />e ime :3 N 2 z Q <br /> <br />MATRIX <br />D <br />1 <br />t G?C <br /> 1 Dis-001A 8/19/10 8hr <br />composite water ? ? <br />1 ? ? 0 0 0 2 <br />9 <br /> ? 11 ? E3 <br />? - <br />Species Name <br /> ? ? ? ? ? 0 F C: C: E: 9 -9 Species Name <br /> 4 ? ? ? ? ? Species Name <br /> 5 ? ? ? ? ? E: I: C: q 7 -9 Species Name <br /> e ? ? ? ? Q E C: 0 [f r CJ Species Name <br /> ? ? ? ? ? c: C 11 E Species Name <br /> e ? ? ? ? ? J J J Species Name <br /> s ? ? ? ? ? Species hlhtne <br /> <br />0 10 ? ? ? ? ? EJ -9 Species Name <br />m <br /> <br />o <br /> <br />Custody <br />Relinquished by: Bob Tennant Date/Time: 8/19/10- 17:00 <br />Shipped by: <br />Received by: g D /D at <br />Ime: <br /> Record MUST Relinquished by: Date/Time: Shipped by: Received <br />by' Date/Time: <br /> be Signed LABORATORY USE ONLY <br />Sample Disposal: Return to Client ? Lab Disposal ® e.,.......,, r....a ., _. <br />.,a-?- ?o rr of tract== <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 orthis possibility. All sub-contract data <br />will be clearly notated on your analytioal report.