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CS <br />8 <br />OR <br />0) <br />Chain of Custody and Analytical Request Record <br />PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 1 of i <br />Company Name: Cotter Corporation Project Name: Schwartrwalder Water Monitoring Program - <br />Tmddng No. 3892013 00179843 DATE: _9/9/10_ SSTF: 9 25189 --- S25193 <br />Report Mail Address: Sampler Name if other than Contact: <br />Cotter Corporation - Canon City Mill Contact Name: Msty Usnick <br />PO Box 1750; Canon City, CO 8121&1750 voice: 1-719-275-7413 ext. 213 Bob Tennant <br />Invoice Address: Invoice Contact Wisty Usnick Purchase Order* ELI Quote # <br />PO Box 1750 Tel: 1-719-275-7413 ext. 213 <br />Canon City, CO 81215-1750 Fax: 1-719-275-1669 <br />Notify ELI prior to <br />Report Required For: POTWMWTP ? RUSH sample Reoei t Temp <br />Other <br />Special Report Formats - ELI must be notified 12 submittal for coo I s <br />F additional charges <br />prior to sample submittal for the following: and achedudn <br />NELAC ? A2LA [I Level IV ? <br />e ustody <br />Other ; Comments: C Seal <br />EDD/EDT El Format S&A Schedule Code : Intact <br />SW CODE 11 Y / N <br />SAMPLE a ~ Signature <br />IDENTIFICATION collection Collection FmWwc.41,4 Y / N <br />(Name, Location, Date Tune Y Match /N <br />LAS N 10 <br />Interval MATRIX p <br />' SW AWD 9/11/10 9:58 Water O ? ? ® O ? O ? O ? ® ? TABLE 1 <br />Y SW A001 9/8/10 11:40 Water ® ? O ? O O ? O O O ® O Code 1 <br />s SW BDIS 0 C30 0 0 013 0 0 0 E3 13 <br />4 SW PL 00 ? 0 0 0 0 0 0 0 0 0 <br />s SW os O O O 0101 0 00 0.13 O <br />° sw Boa QW10 12:00 Water ® O D 0 0 0 0 00 O® O CODE 1 <br />SW GS 9!9/10 8:40 Water 0 13 0 0 0 0 0 0 0 0® O CODE 1 <br />e SW BPL OW10 9.00 Water O D D® O? 0.0 0O® O TABLE 1 <br />° O O? O 10,13 13 E3 [31 El 113 0 <br />10 13 130 0 13 0 0 0 C3113 0 0 <br />Rue by fie! O defied by. Bob Tennant Date/Time:9010 Shipped by: Ft <br />Ned by: Datemme: <br />MUST be Relinquished W. Date/Time: Shipped by: ime: 4141 <br />Signed Semple Disposal: Return to talent ? Lab Disposal ® <br />Z7 ORATORY USE ONL <br />Sample Type 0 of fractions