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 00179384 Water Monitoring Program <br /> REF #/ DATE: 7/20/2010 <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: <br />CANON CITY <br />MILL Invoice Contact & Phone Purchase Order* ELI Quote #: <br />, <br />PO BOX 1750 81215-1750 Kristy Usnick <br />1-719-275-7413 @EX 213 2563 <br />Report Required For. POTWNWVTP ? DW Notify ELI prior to RUSH sample R <br />i t T <br /> <br />Other <br />submittal for additional charges and e <br />emp <br />o <br />Special Report Formats - ELI must be notified prior to .. a ? t? a schedulin Cool r ID s} C <br />sample submittal for the following: <br />? Um' <br />F_ <br />' x 2 <br />= tr Comments: <br />4 <br />NELAC <br />A&A [I Level IV ? <br />Other ? <br />, e <br />E <br />Custody Seal <br />EDD/EDT Format a <br />1 ? Iniact Y R <br /> , to 4 = Signature Y N <br />a <br />SAMPLE IDENTIFICATION Collection Collection <br />I 1 M <br />t h <br />(Name, Location, Interval, etc) Date Time MATRIX oc N? c <br />/? r X Q. ?. a <br />LAB ID <br />Organ pipe 7/20/10 9:10 WATER See table 3 from Randy W Fe .!{- <br /> Species Name <br /> r- r- d r Li Li Species Name <br /> Species Name <br /> Species Name <br /> Species Name <br /> Species Name <br /> Species Name <br /> <br />U <br />l <br />j <br />q Species Name <br /> <br />i <br /> u Species Name <br /> <br />Custody Relinquished by: Bob Tennant 7/20/2010Date/Time: 17:30 Shipped by: R <br />eceived by: Datelrime: <br />Record MUST Relinquished by: Date/Time: Shipped by: Received by: lam- ate/rime: <br />be Signed Sample Disposal: Retum to Client ? Lab Disposal ® LABORATORY USE NLY "7-2Z- to <br /> Sam T # o f a t c <br />s <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.