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?CChain 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 001793414 Water Monitoring Program <br /> REF #/ DATE: 7/23/2010 <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 1-719475-7413 EX 213 <br />Report Required For: POTW/1NWTP ? DW ?.- •- `` 4 , ,.isr: T .. Notify ELI prior to RUSH sample i <br />R <br /> <br />Oth ece <br />r <br />er <br />S <br />ecial Re <br />ort F <br />t <br />ELI <br />t b <br />tif <br />d <br />i submittal for additional charges and •Z.3 <br />p <br />p <br />orma <br />s - <br />mus <br />e no <br />ie <br />pr <br />or to e t a schedulin l <br />C <br /> <br />sample subra ttal for the following: <br />o <br />g <br />t <br />Comments: er <br />oo <br />Ckdftl <br />NELAC ? A21 <br />A ? L <br />l IV ? <br />- <br />eve <br />L co limited <br />-A <br />her <br />EDD/EDT Format <br />a <br />e <br />F <br /> <br />E <br />extended Custoc <br />Intact <br />f <br />ca <br />N <br />~ Si gnat <br /> <br />SAMPLE IDENTIFICATION <br />Collection <br />Collection <br />i <br />n Match <br />(Name, Location, Interval, etc) Date Time 0 2 2 <br /> <br />MATRIX 1 1 L <br />1 orange pipe 7120110 9:10 water ? ? ? O r- r- 1- 11 1-LUF <br />890 7122/10 17:40 Water ? ? ? ? ? Species Name <br /> 7122/10 17:40 water ? ? ? ? D 1: r <br />Species Name <br /> <br />4 ? D ? ? ? Species Name "M F <br />5 ? ? ? ? ? Species Name <br />a ? ? ? ? ? Species Name C <br />' D D ? D D r- c r- 14 11 Species Name 'Xr <br />8 ? ? ? ? ? Species Name <br />9 ? D ? ? ? Species Name ` <br />to El ? ? ? 11 I E: <br />rr- 1: E 11 <br />Species Name <br />Custody Relinquished by: Bob Tennant Date/Time: 7/23/10-16:00 Shipped by: Received by: Date/Time: <br />Record MUST Relinquished by: Date/Time: Shipped by: Received by: 0 gfliJ Date/Time: <br />be Signed <br />I Sample Disposal: Return to Client ? Lab Disposal <br /> Sample Tyne A of fmr.finna <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.