2011-08-09_REVISION - M1981185 ‎(53)‎

• Permit No: M1981185
• IBM Index Class Name: REVISION
• Doc Date: 8/9/2011
• Doc Name: CN-01 112d permit application Exhibit U Attachemnt U-4 part 2
• From: Wildcat Mining Corporation
• To: DRMS
• Type & Sequence: CN1
• Email Name: WHE
• Media Type: D
• Archive: No

Lab Name: Green Analytical Laboratories (970) 247 -4220 FAX [phone]
Analyses Required
Comments
Address: 75: Suttle Street, Durango, CO 31303
' 7'52/ )
Sample. ID
Collection
Miscellaneous I
Preservative(s)
Date
Time
Collected by: (Init.)
v1atris Type
Prottt Table 1
No. of Containers
Sample Filtered ?11,N)
Unpreserved (Ice Only)
£ONI I J
�`IOIJ
t-OSZI-I
HOVN
Other (Specify)
1. - :•
7:,, Cl - _; K
f
; _ .: ; ,
.. ti
r
!f;
a ..:
r:.',; /. /•rti4
.il /t'^ /r
/.'li
Li,/
!
/
1
h1
�.
4.
5.
6. .
7.
8.
9.
Relinquished b ij ...:- - „- ,,77 f� �—^
r:_/ :.` — / /
Date:_.
'
Time:
Received by: .— ,
%
Date:
- ii"., (
Time:
) 1, >e
Relinquished l;y:. t ' -
Date:
Time:
Received by: • '
Date:
Time:
Client: �% i ��rf' /` ::
Contact: ,;4,74../ /;,/,
Address: j : ?”'
//
Phone Number:
FAX Number:
Analytical
Laboratories
* Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days)
CHAIN OF CUSTODY RECORD
1) Ensure proper container packaging.
2) Ship samples promptly following collection.
3) Designate Sample Reject on.
PO#
•
Table 1. — Matrix Type
Surface Water, Z= Ground Water
3 = Soil /Sediment, 4 = Rinsate, 5 = Oil
6 = Waste, 7 = Oth ((Specify)
;" : / Sam lers •Signature„ '� _r, / `
Project Name: i� a. / /i f'': r_.: / !`>' P . Page
i-
of
•
FOR GAL USE ONLY
GAL JOB #