Laserfiche WebLink
v <br />CD <br />W <br />O <br />0 <br />w <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 1 <br />Company Name: Cotter Corporation Project Name: Schwartz - <br />Tracking No. 3692013 00180205 DATE: 2/17/11 SSTF: S25626--S25633 <br />Report Mail Address: Sampler Name if other than Contact: <br />Cotter Corporation - Canon City Mill Contact Name: Randy Whicker 1-303-642-3693 mine phone <br />PO Box 1750; Canon City, CO 81215-1750 Voice: 1-719-275-7413 ext. 210 Bob Tennant 1-719-371-3009-cell <br />Invoice Address: Invoice Contact: JoAnne Ary Purchase Order #: ELI Quote <br />PO Box 1750 Tel: 1-719-275-7413 ext. 209 <br />Canon City, CO 81215-1750 Fax: 1-719-275-1669 <br />Notify ELI prior to Receipt Temp <br />Report Required For: POTWNVWTP ? RUSH sample C <br />Other w submittal for <br />? F C erlD(s <br />Special Report Formats - ELI must be notified o o a additional charges <br />prior to sample submittal for the following: o p m t and schedulin Custody Seal <br />NELAC El A2LA ? Level IV ? ? ay ?Q < o ? Comments: Y / <br />Other ? E a a -?? ; <br />EDD/EDT [I Format S&A Schedule Code : Intact <br />s = ?_ <br />Z ;, c SW CODE 11 Y/N <br />x Table 1 Signature <br />I _ W Fre u 1, Y/ N <br />SAMPLE z n q <br />IDENTIFICATION Collection Collection a? Match LAB ID <br />(Name, Location, Date Time w Y / N <br />Interval, etc MATRIX = w <br />SW AWD 2/15/11 11:20 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1 <br />z SW AOOI 2115/11 11:30 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1 <br />3 SW BDIS 2115/11 14:50 Water ? ? 11 ® ? El 11 ? ? ? 010 Table 1 <br />4 SW PL 2/17/11 8:30 Water R.0 ? ? ? ? ? ? 13 ? ® ? Code 1 <br />5 SW Os 2/17111 8:40 Water ® ? ? ? ? ? ? 010 ? ® ? Code 1 <br />s SW Bps 2117111 8:50 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1 <br />SW GS 2117/11 10:10 Water ® ? ? ? ? ? ? ? [1 ? ® ? Code 1 <br />/171110:20 Water ® ? ? ? ? ? ? ? ? ? ® ? Code 1 <br />PL 2 <br />PE <br />? ? ? ? ? ? ? ? ? ? ? ? <br />? ? ? ? ? ? ? ? ? ? ? ? <br />Relinquished by: Bob Tennant Daterrime:2117/11 Shipped by: Received y. a elTime: ?_?? l X1 <br />Custody 16:00 <br />Record Relinquished by: Date/Time: Shipped by: Received by: Date/ Time: <br />MUST be LABORATORY USE ONLY <br />Signed Sample Disposal: Return to Client ? Lab Disposal 0 Sample Type # of fractions <br />z1Q