2014-04-18_HYDROLOGY - M1994117

• Permit No: M1994117
• IBM Index Class Name: HYDROLOGY
• Doc Date: 4/18/2014
• From: Gold Hill Mines, Inc
• To: DRMS
• Annual Report Year: 2014
• Report Quarter_Month: 1
• Email Name: TC1
• Media Type: D
• Archive: No

10Z Laboratories, Inc. Z 17_��')
Downhill Dnve Steamboat Spnngs, CO 80487 [phone]
Name: Mbk g, A. 't'rsrsw Address: P ©, 5ax jga3
Company: IAIC L' 4 ;r eQ 9-0,50-Z
E-mail: ,eou Tele hone:
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Name:/wnAI��,A) �. /.f alrA/�,/ E-mail: aA&W&-,4dn,,Ap_o.,4 AA 1�@ cAm.11
L FRMAD050.12.12.12 White - Return with sample. Yellow - Retain for your records.
Name: P
Address:
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Company:
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E-mail:
Tele hone:
If sample(s) received past holding time (HT), or if insufficient HT remains to complete
YES
analysis before expiration, shall ACZ proceed with requested short HT analyses?
NO
If "NO" then ACZ will contact client for further instruction. If neither "YES' nor "NO" is indicated, ACZ will
proceed with the requested analyses, even If HT is expired, and data will be qualiSad
Are samples for SDWA Compliance Monitoring?
Yes
No
If yes, please Include t rms. Results will be reported to PQL for Colorado.
Sampler's Name: Sampler's site Information
State: G'©
Zip code A 0362Time Zone M D T
Check box if observe Daylight Savings Time
PROJECT•- •REQUESTED
Quote #:
PO#:
Reporting state for compliance testing:
p
Check box if samples include NRC licensed material?
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MGM t Matrix SW (Surface Water) GW (Ground Water) • WW (Waste Water) DW (Drinking Water) SL (Sludge) • SO (Soil) OL (Oil) Other (Specify)
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Please refer to ACTs terms & conditions located on the reverse side of this COC.
RELINQUISHED BY: D•
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FAAJAIM ., 0114. O.LL I3st NZ / A. -240
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L FRMAD050.12.12.12 White - Return with sample. Yellow - Retain for your records.