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CD <br />CD <br />C1?EY?GY <br />ca do toriEs <br />Chain of Custody and Analytical Request Record <br />PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. <br />Page 1 of 1 <br />Company Name: Cotter Corporation Project Name: Schwartzwaider Water Monitoring Program - Discharge <br />Tracking No. _3692013_00179636 DATE; _9/8/10 SSTF: S25188 <br />Report Mail Address: Sampler Name if other than Contact: <br />Cotter Corporation - Canon City Mill Contact Name: Kristy Usnick <br />PO Box 1750; Canon City, CO 81215-1750 Voice: 1-719-275-7413 ext. 213 Bob Tennant <br />Invoice Address: Invoice Contact: Kristy Usnick Purchase Order #: ELI Quote #: <br />PO Box 1750 Tel. 1-719-275-7413 ext. 213 <br />Canon City, CO 61215-1750 Fax: 1-719-275-1669 <br /> Notify ELI prior to <br />Report Required For. POTWMNYfP El o _ RUSH sample Re `pp <br />a <br />Other is submittal for <br />Special Report Formats - ELI must be notified F additional charges C ler <br />prior to sample submittal for the following: D and scheduling <br />rC ? A2LA El Level N ? <br />NELA O h E 3 o Comments: Cust Y ? Sp?1 <br />? <br />J <br />e <br />EDD/EDT ? Format E `2 <i E S&A Schedule Code Intact <br />, <br /> <br />Z g ~ DIS CODE #4 Y I N <br />SAMPLE <br />IDENTIFICATION <br />Collection <br />Collection I $ K <br />z <br />Frequency: 1 Signature <br />Y / N <br />(Name, Location, Date Time o <br />a Match L A13 ID <br />Interval, etc MATRIX = Y f N <br />DIS-001A 9/8110 com" ite Water ? ® 19 ? ? ? ? ? ? ? ® ? <br />2 ? ? ? ? ? ? ? ? ? ? ? ? <br />3 ? ? ? ? ? ? ? ? ? ? ? ? <br />4 ? ? ? ? ? ? ? ? ? ? ? ? <br />3 ? ? ? ? ? ? ? ? ? ? ? ? <br />e ? ? ? ? ? ? ? ? ? ? ? ? <br />' ? ? ? ? ? ? ? ? ? ? ? ? <br />8 ? ? ? ? ? ? ? ? ? ? ? ? C13 <br />59 <br /> <br />10 ? ? ? ? ? ? ? ? a ? ? ? <br /> <br />Cv:'-dy <br />J Relinquished by: BQb Tennant Date/Time: 918/10 <br />17:00 Shi <br />pped by: <br />Rec ived by, Date/Time: <br />Rte.. <br />MUST <br /> <br />Relinquished b y: Date/Time:y f-ib 1 ;do <br />zz?a-_"?t <br /> <br />Shipped by: <br /> <br />ime: <br />24 <br />Si nec <br />g <br />Sample Disposal: Return to Client ? Lab Disposal ® TORY USE ONLY <br />Sample Type # of froctlons <br />G