2013-12-23_HYDROLOGY - M1977348

• Permit No: M1977348
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/23/2013
• Doc Name: 4th Quarter Groundwater Sampling
• From: Golder Associates
• To: DRMS
• Email Name: ECS
• Media Type: D
• Archive: No

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FRMAD050.12.12.12 White - Return with sample. Yellow - Retain for your records.
IPage 25 of 26
CZ Laboratories, Inc. L /S�l
4Nam;e:Cu_ hill Drive Steamboat Springs, CO 80487 (800) 334 -5493
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Company: I
E- mail: L Telephon `
Name: E -mail:
Company: Telephone: c
Invoice •
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Company:
E -mail: -) (}.� , r
Telephone: -
If sample(s) received p 6l6i ing time (HT), or If insufficient HT remains to complete YES
analysis before expiration, shall ACZ proceed with requested short HT analyses? NO
If "W" then ACZ will caMact client for further Instrudbn N ,nHher "YES" nor "NO" Is Indleatsd, ACZ will proceed with the ngwstsd analysis, ewn If HT Is expind, end data will be 9uslXled
Are samples for SDWA Compliance Monitoring? Yes No
If yes, please include state forms. Results will be reported to PQL for Colors o.
Sampler's Name: Sampler's site Information State: Zip code Time Zone
Check box if observe Daylight Savings Time
Quote #:
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Reporting state for compliance testing: c t �� i
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Check box if samples include NRC licensed material?
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SW (Surface Water) GW (Ground Water) WW (Waste Water) - DW (Drinking Water) • SL (Sludge) • SO (Soil) OL (Oil) - Other (Specify)
O REMARKS
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c Please refer to ACZ's terms & conditions located on the reverse side of this COC.
RELINQUISHED BY: DATEJIME RECEIVED BY: DATEJIME
FRMAD050.12.12.12 White - Return with sample. Yellow - Retain for your records.
IPage 25 of 26