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CZ Laboratories, Inc. <br />2773 DownhNt Drive Steamboat Springs, CO 80487 (800) 334 -5493 <br />Name: Address: 1675 Larimer St Suite 820 <br />any. Star Mine Operations Denver, CO 80202 <br />E -mail: rory@slvrstar.com T hone: 303 - 534 -6500 <br />Name: John R Trujillo E -mail: jrtrujillo@slvrstar.com <br />1company. Star Mine Operations Tel ne: 970 - 596 -4082 <br />Name: Rory Williams Address: 1675 Larimer St Suite 820 <br />Compan : Star Mine Operations Denver, CO 80202 <br />E -mail: rory @sivrstar.com Telephone: 303 - 534 -6500 <br />If samples) received past holding time (HT), or If insufficient HT remains to complete YES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? NO <br />"W*MA=vMMM.CtdN %rWMWMWwc&ML 9 nNW.r'08 am'?Wf* M*%4 WM *'*Mr npwNN . 01rr is Ww�wsd.r.wam.�w <br />Are samples for SDWA Compliance Monitoring? Yes No <br />H yes, please Include state forms. Results will be reported to PQL for Colorado. <br />sampler's Name. Pitts samplers site Information Stab: CO Zip code 81427 Time Zone <br />Check box H observe M savi rammi.Lj <br />Quote M <br />POW � <br />Reporting slue for compliance tesd : 0 <br />Check box if samples include NRC licensed material? c <br />SAMPLE ILENT-IFICATION DA TEJ1%1E b <br />MW -1 9/26/13 11:1 am (,►) 6 <br />MW -2 <br />9/26/13 11:40am <br />MLU <br />6 <br />MW -3 <br />9/26/13 12:15pm <br />AkVj <br />6 <br />MW-4 <br />9/26/13 1:15pm <br />6 <br />1— <br />L—] <br />--- <br />1 <br />1 <br />1 <br />r <br />- <br />Matrix SW (Surfaoe Water) • GW (Ground Water) • W W (Waste We" DW (Drinking Water) • SL (Sludge) • 30 (Sol) - OL (01) - Odxjr (Specify) <br />toic'�i 1SOC.co.l <br />q0 6uC- LP -Wicri <br />gre �le�tck� r big <br />�03- 3(/(o -S►9� <br />Please refer to ACZ's terms &conditions located on the re verse side of this COC. <br />•� 2G � 3 w`. <br />FRMAD050.12.12.12 White - Return with sample. Yellow - Retain for your records. <br />