HYDRO20369

• Permit No: M1977215
• IBM Index Class Name: Hydrology
• Doc Date: 12/29/1998
• Doc Name: BULLDOG MINE RECLAMATION PROJECT
• From: HOMESTAKE
• To: DMG
• Media Type: D
• Archive: No

1 fl
CHAIN OF CUSTODY RECORD Laboratory Sample Numbers (ACZ Use Only): / 7 ~~ ~ coca 16 4 5 2•
Name to Appear ort~ Report and Invoice:; cc: (Report) - (Invoice) to: (circle one or both)
~
~
~'
Y~~-'T~ ~ ~.
N°""'.s
a
(~IIMMO
Laboratories Inc.
2773 Downhill Drive r G So Ga `r ~o ~ n ~ o S ~.~,~' `~-
fJ 2
~"" ~roxc~ scO o JEf C
Steamboat Springs, CO 80487 .
Btsdlttn: el• ~3
e Tel~y/ S a8t
(
p`ttn' ~
[phone] • [phone] al
-
atn
~r I
Pro)ect or P.O. N - A NALY SES REQU ESTE D
~
~ REMARKS
Se. w Read SoSA
7?
°~ W
Gt-u~.. CO Sr(3a
Shipped Va: FED X_ UPS_Hand_Other $ ~~
SAMPLE IDENTIFICATION DATE TIME Semple
M tnz s c0 VI ~ ~ Pa~co.MnttrS
/I.qd Dy S n•s•16 (2:25 6W S 7C N Ls . ~ T 4t. 9~
ll•gE W6t. Wa.i~ 11•S• 8 12:45 SIN/ S /~ ~y3 •S`/ s$
~,.. ! $MR Waii /. D I/; 20 SW S X o . ,9 5 ~,.. T. 3S.
p• d 7rt,~t T, 1•~• ! 12:4e SW S X N ,,x.38 Cwd. 22 HS ~+ = 42•
,Y W-3 ~ lr•7• b r3:1S Gw s x 6.~z .248 ~K T• a
I/ Nw _ z_ ` n- 8 / S:Ia C,~I.U z Cs 1 8 ~ .. __ Z .
eo cde.~r a• S /5:30 BUJ S •63 ~. 83 ~ _ s
ll•8~ ,-6:eS G~ S. ~ N ,~.SD Co+e1. 315 --- -

K f
• Matrllc Opibns: SW (Surface water) • GW (Ground water) • W W (WastewSter) • DW (Drinking water) • SL (Sludge) • SOIL • OIL • Other (Speciy) CO MMENTS
SAMPLE DISPOSAL OPTIONS -Please complete section A, or choose one option from asctlons BAND C.
Proper charges will bs aeaesaed.
(A) Long-term storage Semple la Non-Hazardous (C)11 Sample Is Hazardous
Hold until (date) 1) I Disposal t) RCRA-Permitled Facility
for firture analysis. RCRA -Permitted Facility 2) Return to Client
3) Return to Client
RELINQUISHED BY: (SIGNATUR E) DATE TIME RECEI D BY: (S IGNATURE) DATE TIME PAGEIf
~...a~-4~ i(- 8 ~~ ~ i I ~ to a -
•, OF
C • --

/temple
- Le ,. ,~•
Yellow • Return w/ sample
Pink - Return w/ sample
(itlltl - K6ep for your reCOrdS
,~
<~