2014-07-21_HYDROLOGY - M1983141

• Permit No: M1983141
• IBM Index Class Name: HYDROLOGY
• Doc Date: 7/21/2014
• From: Gold Hill Mines, Inc
• To: DRMS
• Annual Report Year: 2014
• Report Quarter_Month: 2
• Email Name: TC1
• Media Type: D
• Archive: No

A,CZ Laboratories, Inc.• 6,21 •'
2773 Downhill Drive Steamboat Springs, CO 80487 800 334-54-93
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Name; Address: S reN Address: O kg23
Com an : A L4 t d T 4502.
E-mail: ' Telephone:
Copy of Report
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Invoice to:
Name MA&K Tt2�/V Address: Ad 80 1525
Company: / 11VIC (D 12
E-mail `
Telephone: ^ 9�
If samples) 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" the. 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 he qualified
Are samples for SDWA Compliance Monitoring? Yes No
If yes, please include state forms. Results will be reported to PQL for Colorado.
Sampler's Name: Sregdnfey/ Sampler's site Information State:(77 0 _Zip code o3C�2Time Zone /��
Check box if observe Daylight Savings Time
PROJECT INFORMATION ANALYSES REQUESTED (attach list or use quote number)
Quote #:
PO#:
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Reporting state for compliance testing: O p
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Check box if samples include'NRC licensed material? c
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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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CZMARKS
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Please refer to ACZ's terms & conditions located on the reverse side of this COC.
RELINQUISHEDD• D•
9411-
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FRMADi 50 12.12.12 White - Return with sample. Yellow - Retain for your records.