Laserfiche WebLink
W <br />W <br />0 <br />A <br />W <br />RrArorr t <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: Schwartzwalder Water Monitoring Program - <br />Tracking No. 3692013 00179841 & 00179858 DATE: _11/03/10 SSTF: S 25278---525285 <br />Report Mail Address: Sampler Name if other than Contact: <br />Cotter Corporation - Canon City Mill Contact Name: Kristy Usnick 1-303-642-3893 mine phone <br />PO Box 1750; Canon City, CO 81215-1750 Voice: 1-719-275-7413 ext. 213 Bob Tennant 1-719-371-3009-cell <br />Invoice Address: Invoice Contact: Kristy Usnick Purchase Order ELI Quote #: <br />PO Box 1750 Tel: 1-719-275-7413 ext. 213 <br />Canon C4, CO 81215-1750 Fax: 1-719-275-1669 <br /> Notify ELI prior to <br /> <br />Report Required For. POTI1VNMTP C3 <br />e <br />RUSH sample Recei <br />p p <br />Other <br />Special Report Formats - ELI must be notified is <br />E ,. submittal for <br /> <br />additional <br />rges <br /> <br /> <br />i°?[er 1D(s <br />prior to sample submittal for the following: P ° <br />Tm <br />' w W <br />a and <br />4 <br />schedui u U <br />NELAC.n A2LA ? Level IV ? ° <br />N <br />° m s <br />° ° ° <br />` Comments: Custody eal <br />Other E3:'a <br />2 a g a = Y / h! <br />EDD/EDT [] Format E <br />a C a o a S&A Schedule Code : Intact <br /> z ° °0 = W - SW CODE I- 1 YIN <br />SAMPLE ! o a x Table 1 Signature <br />IDENTIFICATION Collection Collection 2 v? z <br />o a Frequency 1,2.3,4 Y / N <br />(Name, Location, Date I Time 7 ° w 2 COOLER Match LAB ID <br /> <br />Interval, etc <br />MATRIX <br />a <br />10 Y/N <br />1 SW AWD 11/02110 11:25 Water ? ? ? ® ? ? ? ? ? ? ® 11 ? Tablel <br />2 SW A001 11/02/10 13:20 Water ® ? ? ? ? ? ? ? ? ? ® ? Code l <br />3 SW BDIS 11/02/10 16:05 Water ® ? ? ? ? ? ? ? ? ? ® ? Code I <br />4 SW PL 11/03/10 8:40 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1 <br />5 SW CS 11/03/10 10:10 Water ? ? ? ® ? ? ? ? ? ? ® ? Table I <br />a SW BOS 11103110 11:20 Water ® ? ? ? ? ? ? ? ? ? ® ? Code I <br />SW GS 11/03110 11:35 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1 <br />a SW BPL 11/03/10 13:45 Water ? ? ? ® ? ? ? ? ? ? ® ? Table 1 <br />9 ? ? ? ? ? ? ? ? ? ? ? ? <br />10 ? ? ? ? ? ? ? ? ? ? ? ? <br /> <br />Custody Relinquished by: Bob Tennant Date/Time:11/03/10 <br />16:30 i <br />Shipped by: <br />Received by:61 <br />' e: <br />Al <br /> <br />R <br />d !nslm <br />MUST be <br />ecor <br />Relinquished by: Date/Time: <br />Shipped by: <br />Received by: Date/Time: <br />Signed <br />Sample Disposal: Return to Client El Lab Disposal ® <br />I LABORATORY USE ONLY <br /> Sample Type_ # of fractions <br />/S