2013-08-20_HYDROLOGY - M1977300 (3)

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CD CD N N Chain of Custody and Analytical Request Record PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page I of 1 Company Name: Cotter Corporation Project Name: Schwartz - , Tracking No. 45931688 6328 DATE: 6/07/13 SSTF: S26942 & S26943 Report Mail Address: Sampler Name if other than Contact: Cotter Corporation - Canon City Mill Contact Name: Frank Adamic 1-303-642-3893 mine phone PO Box 1750; Canon City, CO 81215 -1750 Voice: 1- 719 - 275 -7413 ext 204 Bob Tennant 1- 719 - 371 - 3009 -cell Invoice Address: Invoice Contact: JoAnne Ary Purchase Order #: ELI Quote #: PO Box 1750 Tel: 1- 719 - 275 -7413 ext. 209 Canon City, CO 81215 -1750 Fax: 1- 719 -275 -1669 Report Required For: POTWAWITP ❑ ANALYSIS REQUESTED Notify ELI prior to RUSH sample Rece� p Other Special Report Formats - ELI must be notified to sample submittal for the following: Vol � submittal for a additional charges C �o fer t s) prior g t and schedulingC• NELAC ❑ A2LA ❑ Level IV ❑ Other g a g Comments: Custody § I C/�'-N. EDD /EDT El Format ? S&A Schedule Code: Intact N - 2 G = Y / N Signature SAMPLE IDENTIFICATION Collection Collection w F uen Y / N Match LAB ID {Name, Location, Date Time Y/N Interval, etc MATRIX a ' Sump-8 6/07113 8:15 Water 6 ® ❑ ❑ ❑ ❑ 1 D ❑ ❑ ❑ ❑ ® ❑ �- 2 SUMP-1 6/07/13 8:45 Water 6 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ 3 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ W ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 01010 5 01010 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ e ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0-10 tt— 7 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ C3 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ _J ,o ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ "Received Custody Refinished Tenn Datelime:6/07 /1317:00 Shipped by: FedEx by: Date/Time : Record Refnquished by: Date/Time: Shipped by: y rme MUST be Signed Sample Disposal: Retum to Client ❑ Lab Disposal LABORATORY USE ONLY Sample Type # of fractions rx -. i"