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Company Name: Cotter Corporation <br />Tracking No. 3692013 61576016 <br />Project Name: Schwartz - <br />DATE: 4112/11 SSTF: S257O2-- -S25709 <br />Report Mail Address: <br />Cotter Corporation - Canon City Mill <br />PO Box 1750; Canon City, CO 81 <br />Contact Name: Randy Whicker <br />1- 719 - 275 -7413 ext. 210 <br />Sampler Name if other than Contact: <br />1- 303 -642 -3893 mine phone <br />Bob Tennant 1- 719- 371- 3009 -cell <br />Invoice Address: <br />PO Box 1750 <br />Canon City, CO 81215 -1750 <br />Invoice Contact JoAnne Ary <br />75 -7413 ext. 209 <br />Fax: 275 - 1669 <br />Purchase Order #: <br />ELI Quote #: <br />Report Required For: P( <br />Other <br />Number of Container <br />Sample Type: <br />—i AWSVBO <br />air, Water $oilslSo(ids. Vegetation. <br />X Hioassay other <br />I Normal Tumaround (TAT) <br />Notify ELI prior to <br />RUSH sample <br />submittal for <br />P additional charges <br />t and scheduling <br />Receipt T p <br />C <br />U - dissolved only - CODE *1 <br />U - total & dissolved - CODE #3 <br />Ra-226 total & dissolved CODE#3 <br />SEE ATTACHED TABLE 1 <br />ow er ID(s) <br />Special Report <br />prior to sample <br />NELAC • <br />EDD /EDT <br />Formats — ELI mu <br />submittal for the f <br />A2LA • I <br />[] Format <br />RUSH Turnaround (1 <br />• <br />Comments: <br />S&A Schedule Code : <br />SW CODE 11 <br />Table 1 <br />Frequency 1, <br />Two coolers <br />Cus ody Seal <br />Y / <br />Intact <br />Y I N <br />Signature <br />Y I N <br />Match LAB ID <br />Y / N <br />SAMPLE <br />IDENTIFICATION <br />(Name, Location, <br />Interval, etc) <br />Collection <br />Date <br />Collection <br />Time <br />SW AWD <br />4/12/11 <br />11:05 <br />Water <br />® <br />❑ <br />❑ <br />❑ <br />• <br />❑ <br />❑ <br />❑ <br />❑ <br />• <br />0 <br />• <br />Code 1 <br />SW A001 <br />4/12111 <br />11:25 <br />Water <br />® <br />❑ <br />❑ <br />• <br />• <br />❑ <br />• <br />❑ <br />❑ <br />• <br />® <br />• <br />Code 1 <br />SW BDIS <br />4/12/11 <br />11:35 <br />Water <br />❑ <br />❑ <br />• <br />❑ <br />❑ <br />• <br />❑ <br />❑ <br />• <br />-o <br />❑ <br />Code 1 <br />SW PL <br />4/12/11 <br />11:45 <br />Water <br />0 <br />❑ <br />• <br />❑ <br />• <br />• <br />❑ <br />❑ <br />❑ <br />• <br />0 <br />❑ <br />Code 1 <br />SW OS <br />4/12/11 <br />13:20 <br />Water <br />El <br />❑ <br />• <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />• <br />0 <br />• <br />Code 1 <br />e SW BOS <br />4/12111 <br />13:30 <br />Water <br />0 <br />❑ <br />❑ <br />• <br />• <br />• <br />• <br />• <br />❑ <br />• <br />0 <br />❑ <br />Code 1 <br />SW GS <br />4/12/11 <br />13:40 <br />Water <br />0 <br />❑ <br />❑ <br />• <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />0 <br />❑ <br />Code 1 <br />e SW BPL <br />4/12/11 <br />13:50 <br />Water <br />c- <br />• <br />❑ <br />• <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Code 1 <br />a <br />❑ <br />• ❑ <br />❑ <br />• <br />• <br />• <br />. ❑ <br />��r <br />(ic <br />10 <br />❑ <br />❑ � <br />❑ <br />❑ <br />1 <br />0 <br />• <br />,•''❑ <br />❑ ❑ <br />❑ <br />Custody <br />Record <br />MOST be <br />Signed <br />Relinquished by: Bob Tennant Date/Time:4 /13/11 11:00 <br />Sh pped by: , <br />Shipped by: <br />, Received by • - - ime:/# /jl <br />Relinquished by: Date/Time: <br />Received by: Date/Time: 163D <br />Sample Disposal: Return to Client • Lab Disposal 0 <br />LABORATORY USE ONLY <br />Sample Type # of fractions <br />CO <br />0 <br />0 <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 />