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I'\ <br />J M Inter- Mountain Labs <br />Sheridan. WY and Gillette, WY <br />INTER- MOUNTAIN LABS <br />- CHAIN OF CUSTODY RECORD - <br />Page 1 of 1► <br />All shaded fields must be completed. <br />This is a legal document, any misrepresentation ma unslrued as baud <br />#WEB ///��I <br />gI,y.Ty OS,�lI <br />- , - . 1 I <br />Client Name <br />New Horizon Mine <br />Project Identification <br />PR08 <br />Sampler ( <br />ation Authenticity) Telephone # <br />970 -428 -1076 <br />Report Address <br />PO Box 628 <br />Nuela, Colorado 81424 IlEmail <br />Contact Name <br />Tom Fry <br />VA44ALYSES <br />/ PARAMETERS <br />tfry@tristategt.org <br />Invoice Address Phone 970 - 428 -1073 <br />PO Box 628 Purchase Order # Quote # <br />Nucla, Colorado 81424 1 <br />REMARKS <br />LAB ID <br />Lab Use Ord) <br />DATE I TIME <br />SAMPLED <br />SAMPLE <br />IDENTIFICATION <br />Matrix <br /># of <br />Containers <br />sjqOS3T <br />5-9-14 <br />940 <br />SS -87 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />5 -9 -14 <br />9:15 <br />SS -91 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />5 -9 -14 <br />9:53 <br />SS -83 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />4 -30 -14 <br />16:26 <br />SS -77 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />4 -30 -14 <br />15:29 <br />SS -81 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />4 -23 -14 <br />14:08 <br />SS -86 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />4 -23 -14 <br />14:14 <br />SS -90 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />4 -30 -14 <br />1516 <br />SS -80 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />5 -9 -14 <br />&39 <br />SS -82 - 0 -2 feet <br />soil <br />1 <br />table submitted <br />T-YOK47 Ferris <br />5 -16 -14 <br />11.45 <br />SHIPPING INFO <br />❑ UPS <br />L3 FedEx <br />LI USPS <br />❑ Hand Carried <br />LI Other <br />MATRIX CODES <br />Water WT <br />Soil SL <br />Solid SD <br />Filter FT <br />Other OT <br />TURN AROUND TIMES <br />Ch ck desired service <br />Standard turnaround <br />RUSH - 5 Working Days <br />:_I URGENT - < 2 Working Days <br />Rush 8 Urgent Surcharges will be applied <br />COMPLIANCE INFORMATION <br />Compliance Monitoring ? <br />Program (SDWA, NPDES,... <br />PWSID / Permit # <br />Chlorinated? Y / <br />— -n le Disposal: Lab Client <br />ADDITIONAL REMARKS <br />Inte ain Labs, Inc. www intermi ebs.com Rev <br />