2009-10-21_HYDROLOGY - C1981035

• Permit No: C1981035
• IBM Index Class Name: HYDROLOGY
• Doc Date: 10/21/2009
• Doc Name: 3rd Quarter 2009 Field Well Water Analysis ‎(King I & King II)‎ emailed
• From: GCC Energy
• To: DRMS
• Permit Index Doc Type: Other Ground Water
• Email Name: TAK
• Media Type: D
• Archive: No

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Analytical
Laboratories
Client: C- C C N /> C y, LL
Contact -7- .. 1,3iA 42
Address: L/L1'Zq G
fi' 'S 4?5'-e' S C- C.,
Phone Number. ?-7,r
FAX Number ?7 c+ _ S l!t >
CHAIN OF CUSTODY RECORD Page ! of
NOTES:
1) Ensure proper container packaging. Table 1. - Matrix Type FOR GAL USE ONLY
2) Strip samples promptly following collection. I = Surface Water, 2 = Ground Water GAL JOB #
3) Designate Sample Reject Disposition. 3 = Soil/Sediment, 4 = Rinsate, 5 = Oil loo/
PO# 6 = Waste, 7 = Other (Specify)
Project Name: /1„t? t ' ,k' n'6 ZL Samplers Signature:
Lab Name: Green Analytical Laboratories [phone] FAX [phone] An alyse s Required
Address: 75 Suttle Street, Durango, CO 81303
Collection Miscellaneous Preservative(s)
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Sample ID Date Time Comments
J' E

V
X E
?
a
O
1 O
y
O i.
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c
U 2 0
tz. o
z
.n c
a Z U c?
x <
z
0

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i? q I.'4'- wi
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5.
6.
7.
8.
9.
10.
Relinquished Date: 2 Time: Received by: ' Dat : Twne:.
Relinquished by. Date: Tmie: Received by- V Date: Twae
* Sample Reject [ ] Return ( 1 Dispose [ ] Store (30 Days)