2018-08-08_HYDROLOGY - M1977348

• Permit No: M1977348
• IBM Index Class Name: Hydrology
• Doc Date: 8/8/2018
• Doc Name: Water Monitoring - Groundwater
• From: Golder Associates
• To: DRMS
• Annual Report Year: 2018
• Email Name: AME
• Media Type: D
• Archive: No

M
0
0
3
v
t~
0
ACZ Laboratories, Inc. �` L} b 6 •
2773 Downhill Drive Stearnboaq Springs, CO 80487 [phone]
Name: -
Address: SV,
Com an : 'k,
tco p ZI Z
E-mail:
P.lrCl.Xh Telehone:
ReportCopy of
Name: Yard ✓
�5 E-mail: Ss�Gt�F 6
Company:
I ITelephone: (2
Invoice to:
Name: Address:
Company:'
om an
E-mail:
Telephone:
If sample(s) received past hot
ng time (HT), or if insufficient HT remains to complete YES
�(
analysis before expiration, sh
I ACZ proceed with requested short HT analyses? NO
If "NO" then ACZ will contact anind for further in
•tion. N neither "Ti8" nor "NO" is indicated, ACZ will proceed with the regwsled anztyxs, even N HT expired, and data veil be gwliRsd
Are samples for SDWA Compi
nce Monitoring? Yes No
If yes, please include state fon
s. Results will be reported to PQL for Colorado.
Sampler's Name:
Samplers site Information State CD Zip code Time Zone
`Sampler's Signature.
h atlest to gre •ultnrtdly Nand validity of this sample. i understand that IMerdiondly mislabeling the tlmeldaNAooallon or
tampering wNh the sample in anyway, is considered fraud and punishable by drab taw.
PROJECT•' •
Quote #:
le,
PO#:
d t3C3
c
state for compliance t
ting.Coox
if samples include NR
licensed material? cto
®Reporting
to3s
6
� td, 1355
3
MW -4
6161IR Isif
3
ftA tiU S
WOW C1 15
3
X
vv -iv
614hq
. \ • VJ /
1
61 hal W 1140 C
3
3
Matrix SW (Surface Water) G
(Ground Water) WW (Waste Water) DW (Drinking Water) - SL (Sludge) • SO (Soil) - OL (Oil) • Other (SpecifyE])
i
Please refer
to ACTS terms & conditions located on the reverse side of this COC.
RELINQUISHED :
e• D.
�4$�ZAba3i�05 White - Return with sample. Yellow- Retain for your records.
Page 24 of 24