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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 00179476 Water Monltoring Program <br /> REF #/ DATE: 8/6/2010 <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: POTWNW(TP ? DW Notify ELI prior to RUSH sample <br /> Recei <br />Other <br />3 <br />[ 1= submittal for additional charges and ?v <br />Special Report Formats - ELI must be notified prior to '0 o a schedulin <br />C <br />l <br />sample submittal for the following: <br />NELAC ? A2LA ? L <br />l IV ? a rim W t Comments: er <br />oo <br />eve 75 m limited Custod <br />Other <br />a <br />E <br />extended <br /> <br />Int <br />t <br />EDD/EDT Format a ac <br /> <br />SAMPLE IDENTIFICATION MW-6 ONE SAMPLE FROM Signah <br />Match <br /> Collection Collection >+ i $ 8/5/10 9:32 00179469 <br />(Name, Location, Interval, etc) Date Time <br /> <br />MATRIX ? ? <br />it <br />0: v L <br />1 Dis-001A 816/10 8hr <br />composite water ? ? ? ? 1cnt87 <br />2 ? ? ? ? ? Species Name <br /> ? ? ? ? ? I_ C: r C: Species Name <br />' ? ? ? ? ? <br />1 E E C C C Species Name <br />s ? ? ? ? ? C: E E: r F 9 Species Name <br />s ? ? ? ? ? Species Name <br /> ? ? ? ? ? <br />9 <br />Species Name <br />e ? ? ? ? ? Species Name <br />s ? ? ? ? ? E C 1: 1: Species Name <br />,o ? ? ? ? ? Species Name <br /> <br /> <br />Custod Relinquished by: Bob Tennant Date/Time: 8/6/10. 14:00 Shipped by: Received by: 11 <br />?JO1Z <br />/Time: <br />y <br />Record MUST <br />Relinquished by: Date/Time: <br />Shipped by. <br />R ived ate/Time: <br />be Signed Sample Disposal: Return to Client ? Lab Disposal ® LAB ORY USE ONLY <br /> amp! vpe # of fractions <br />In certain circumstances, samples submitted to Energy Laboratories, Inc. may be subcontracted to other certified laboratories in order to complete the saalysis requested. serves as notice <br /> of this possibility. All sub-contract data <br />will be clearly notated on your onatyticnl report.