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? -44 <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 2 of 2 <br />Company Name: Cotter Corporation Project Name: Schwartzwalder <br />Tracking No. 3892013 00179490 Water Monitoring Program <br />Tracking No. _3692013 00179506 <br /> REF #/ DATE: 8/ 11/2010 <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 8r 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. POTWNVWTP ? DW Notify ELI prior to RUSH sample R <br />Oth submittal for additional char <br />es and <br />er g <br />Special Report Formats - ELI must be notified prior to -l <br />.. o scheduling C <br />l <br /> o <br />8 oo <br />er <br />sample submittal for the following: <br />J m <br />J <br />= <br />Comments: <br />F <br />NELAC ? A2LA ? Level IV ? ' <br />?? <br />A <br />061 <br />v <br />k <br /> <br />C stod <br />Other , <br />a 8 Extended <br />EDDIEDT Format 8 y a Signatt <br /> <br />SAMPLE IDENTIFICATION <br />Collection <br />Collection Z I$ <br />ai>i a o <br />iE n Table 1 Match <br />(Name, Location, Interval, etc) Date Time w d/SL <br /> MATRIX <br />SW-LLHG 8/11/2010 10:30 Water ? ? ? m r- r- 1: 0 c4 11 cl <br />SW-ARH 8111/2010 12:20 Water ? ? ? ? <br />SW-FBRG 8/11/2010 14:20 Water ? ? ? ? <br /> ? ? ? ? ? <br /> . 0 ? ? ? ? <br />Er: q <br />q c: <br /> ? ? ? ? ? <br /> ? ? ? ? ? <br /> ? ? ? ? ? <br />I <br />s <br /> ? ? ? ? ? '/or :S3 <br />E <br />E <br /> ? p [] I] [] <br />= <br />E <br />11 SHAFT-80OFT 7122110 17:40 <br />t <br />d <br />C Relinquished by: Bob Tennant Date/Time: 8/12/10-10:00 Shipped by: Received by: Date/Time: <br />us <br />o <br />y <br />Record MUST <br />Relinquished by: Date/Time: <br />Shipped by: <br />G e <br />Received by: 9' e/Time: <br />be Signed Sample Disposal: Return to Client ? Lab Disposal LABORATORY USE ONLY <br /> Sample Type <br /># of fraction s <br />T <br />N <br />CD <br />N <br />0 <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 oloady notated on your analytical report-