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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 3 <br />Company Name: Cotter Corporation Project Name: Schwartzwalder <br />Tracking No. 3692013 00179544 Water Monitoring Program <br />REF #1 DATE: 8118/10 <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: POTWNWVTP ? DW Notify ELI prior to RUSH sample Receipt-7e <br />Other a b a submittal for additional charges and tr - <br />Special Report Formats - ELI must be notified prior to o t? a scheduling Coglej ID(s) <br />sample submittal for the followin : m W .2 Comments: ?E <br />NELAC ? A2LA ? Level IV El $ m ro 5 e I Custody Sealy <br />Other <br />EDD/EDT Format c Signature Y N <br />z g H Match <br />SAMPLE IDENTIFICATION Collection Collection }>I .9 ' 0 <br />(Name, Location, Interval, etc) Date Time MATRIX ' ' z LAB ID <br />SW-BDSI 8/18/10 12:08 Water r- E: Species Name <br />SW-PL 8/18/10 12:13 Water Species Name <br />SW-0S 8/18/10 12:24 Water Species Name <br />SW-80S 8/18/10 13:10 Water r- C Species Name <br />SW-GS 8/18/10 13:24 water 0 r- 1: E Species Name <br />x SW-AWD 8/18/10 12:45 Water is r C: d CJ L Li Species Name <br />SW-AO01 8/18/10 10:35 Water See att. Table 1 extended suite <br />" 8/18/10 8:50 water See att. Table 1 extended suite <br />D SW-BPL <br />Species Name <br />D <br />(I mild C Species Name <br />J <br />Relinquished by: Bob Tennant 8/19/09 12:00 Date/Time: Shipped by: Received by: at ime: <br />Cutody Received by: Date/Time: /O <br />[Recorsd MUST Relinquished by: Date/Time: Shipped by: (kAV <br />be Signed LA RATORY USE ONLY <br />Sample Disposal: Return to Client ? Lab Disposal ® Sample Type # of fractions <br />'Mis eerves as notice of this possibility. AU sub-contract data <br />er ruueu :eocadW'Wb m wuc. w w...y .? « .- - - ---' -- - <br />In certain circumstances, samples submitted to Energy Laboratories, Inc. may be snpCOntraCieO to Om cc <br />mill fia nlonriv nntntnA on vnnr nnnlvtirnl rnmrr