2013-08-20_HYDROLOGY - M1977300 (4)

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v Company Name: Cotter Corporation Project Name: Schwartz - Tracking No. 4593 1688 6512 DATE: 6123113 SSTF: S26948 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 AAiL1LYS€s REQUESTED Notify ELI prior to Report Required For: POTWNVWTP ❑ RUSH sample R pC Other F submittal for ° Special Report Formats — ELI must be notified .. o a F additional charges er ID(s) prior to sample submittal for the following: 3 1m .1i � � and scheduling Ct Z NELAC ❑ A2LA ❑ Level IV ❑ o y g Comments: Custody i Other � � e Y / EDD /EDT ❑ Format E El S&A Schedule Code: Intact — GW CODE: Y /(A� SAMPLE � N � � Signature IDENTIFICATION Collection Collection °C F uenc : Match LAB ID (Name, Location, Data Time ` Y / N Interval, etc MATRIX '- MW -20 6/23/13 11:30 Water 6 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ >- 2 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 2C 3 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ © ❑ ❑ ❑ UJ 4 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 3 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 01010 ❑ ❑ ❑ �- ' 010,0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ F0 ❑ e ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ as s ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ o ❑ ❑ 10 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ CD IffiW Chain of Custody and Analytical Request Record PLEASE PRINT; provide as much information as possible. Refer to corresponding notes on reverse side. Page 1 of Custody Relinquished : Bob Tennant Date/Time:6/24 /1317:00 Shippe b : FedEx Received by: DatelTme: Record Relinquished by: DatefT Tune: Shipped by: Received by: Date/Time: MUST be Signed Sample Disposal: Return to Client ❑ Lab Disposal ® LABOItATORY USE ONLY Sample Type # of fractions