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Company Name: Cotter Corporation <br />Tracking No. 3692013 62583594 <br />Project Name: Schwartz - - <br />DATE: 2/19113 SSTF: S26796 S26798 <br />Report Mail Address: <br />Cotter Corporation - Canon City Mill <br />PO Box 1750; Canon City, CO 81215 -1' <br />Contact Name: Frank Adamic <br />.,_:__: '19- 275 -7413 ext. 204 <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 />13 ext. 209 <br />669 <br />Purchase Order Al: <br />EU Quote t <br />Report Required For. POTWM <br />Odor <br />5 Number of Contains <br />Sample type: <br />AWSVBO <br />a l Air, Water <br />X I lolls/Sollds, Yspetetlon <br />ANALYSIS REQUESTED <br />(_Y.L) PunoJewni ptuioN <br />Notify EU prior to <br />RUSH sample <br />submittal for <br />a add charges <br />t and scheduling <br />Receip T p U <br />° C <br />tit 300 - Huo P9Nos9tP - n <br />el 3000 - PoA S$ 1 n <br />£•3000 PaMOSSSP'8 I 8ZZ <br />1 Flan 03HYLLY 338 <br />Cooler ID(s) <br />C t-e� <br />Special Report <br />prior to sample <br />NELAC • <br />Other <br />EDD/EDT <br />Formats -- ELI must be r <br />submittal for the following: <br />A2LA ❑ Level I� <br />❑Forma# <br />Custody <br />Y igai <br />Intact ( <br />Y eV <br />Signatu <br />Y <br />Match I <br />Y / <br />RUSH Turnaround <br />Comments: <br />SM Schedule Code : <br />SW CODE 13 <br />Table 1 <br />Frequency! 4, <br />Two coolers <br />SAMPLE <br />IDENTIFICATION <br />(Name, Location, <br />interval, etc) <br />Collection <br />Date <br />Collection <br />Time <br />1 SW FBRG <br />2/19/13 <br />11:50 <br />Water 3 <br />❑ <br />® <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />T� <br />® <br />❑ <br />Code 3 <br />a•- <br />r <br />2 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />U <br />❑ <br />❑ <br />❑ <br />r—�-- <br />� <br />O <br />3 SW LLHG <br />2/19/13 <br />12:55 <br />Water 3 <br />❑ <br />® <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />® <br />❑ <br />Cade 3 <br />W <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />M <br />a <br />0 <br />m <br />0 <br />• <br />0 <br />0 <br />0 <br />0 1 <br />0 <br />• <br />0 <br />>" <br />° <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />■ <br />7 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />c <br />8 <br />0 <br />0 1 <br />0 <br />0 <br />0 <br />0 <br />E 1 <br />0 <br />0 <br />0 <br />0 <br />❑ <br />a <br />9 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />D <br />to <br />❑ <br />s <br />❑ <br />❑ <br />❑ <br />0 <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Cif <br />,C.Ani_120 <br />Received by Date/Time: <br />Custody <br />Record <br />MUST be <br />Signed <br />Relinquished by: Pob Tennant Date/rime:2/19/1316:30 <br />Shipped by: FedEx <br />Shipped by: <br />Relinquished by: Date/Time: <br />Received by: Date/Tirne: 2 - l - <br />Sample Disposal: Return to Client ❑ Lab Disposal ® <br />LA =' ��TORY USE ONLY <br />Sample Type *of fractions <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 />