2008-09-02_HYDROLOGY - M1984049

• Permit No: M1984049
• IBM Index Class Name: HYDROLOGY
• Doc Date: 9/2/2008
• Doc Name: Water Sample July 21, 2008 Pride of the West Mill
• From: Colorado Goldfields, Inc
• To: DRMS
• Email Name: WHE
• Media Type: D
• Archive: No

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Analytical

Phone Num r: - Q -
FAX Number.
CHAIN OF CUSTODY RECORD Page of
NOTES: _
l) Ensure proper container packaging. Table 1. -Matrix Type FOR GAL USE ONLY
2) Ship samples promptly following collection. I = Surface Water, 2 = Ground Water GAL JOB #
4,333) Designate Sample Reject Disposition. 3 = Soil/Sediment, 4 = Rinsate, 5 = Oil
PO# 6 = Waste, 7 = Other (Specify)
Project Name:
SzSL- - F 4-4 s 2-SG „-,- "r P.
S'a'tm'?plers Signature:
-
Lab Name: Green Analytical La or o es, Inc. [phone] FAX [phone] -
Analyses Required
Address: 75 Suttle Street, Durango, CO 81303
Collection Miscellaneous Pre servative (s)

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Sample ID Date Time D Comments
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3. PP 7 1( u01
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7.
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10.
Relinquished Date:? p Og Timey,?
l Received T'

Relinquished Date: Time: Received b Date: Time:
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* Sample Reject: [ ] Return [ ] Dispose [ J Store (30 Days)
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