2014-10-10_HYDROLOGY - M1983141 ‎(3)‎

• Permit No: M1983141
• IBM Index Class Name: Hydrology
• Doc Date: 10/10/2014
• From: Gold Hills Mines, Inc
• To: DRMS
• Annual Report Year: 2014
• Report Quarter_Month: 3
• Email Name: MAC
• Media Type: D
• Archive: No

ACZ Laboratories, Inc. C����� •'
2773 Downhill Drive Steamboat Springs, CO 80487 [phone]
Name:T- Address: �r 4 t 23
Company: 1 -' r rWMAAz
E-mail: Telephone: -
Copy of Report
Name: • (jQ�p E-mail:
Company: /LL./ Telephone: - -
Invoice to:
Name: - Address: 0 2
Company: -' ✓rD2
E-mail: Telephone: 2Lo"
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 qualified
Are samples for SDWA Compliance Monitoring? Yes No
If yes, please includestateforms. Results will be reported to PQL for Colorado.
Sampler's Name: 4 7 W SC I ampler's Site Information State iA Zip code 60:7,o2 -Time Zone iM 22VC
•1 attest to the authenticity and validity of this sample. I understand that intentionally mislabeling the timeldatenocation or
"Sampler's Signature:. tampering with the sample In anyway, Is considered fraud and punishable by State Law.
PROJECT•- • • ' (attach list or use quote number)
Quote #:
E-~
PO#:
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Reporting state for compliance testing: v 1
c
Check box if samples include NRC licensed material? c A
0)4692A— } % ►�
a --M,d
✓
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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)
REMARKS
At-t-
Pleaserefer to ACZ's terms & conditions located on the reverse side of this COC.
RELINQUISHED BY: D• D•
AA !1Z R
p3NIkr I
UMISIODPOMM!90 White - Return with sample
Yellow - Retain for your records 1,(IP4g-Vk.6f 19Z75 -Y