2012-07-12_GENERAL DOCUMENTS - C1981008 ‎(3)‎

• Permit No: C1981008
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 7/12/2012
• Doc Name: Soils Data from OSM
• From: Rick Williamson- OSM
• To: Chris Kamper
• Permit Index Doc Type: General Correspondence
• Email Name: DAB
• Email Name: MLT
• Email Name: SB1
• Media Type: D
• Archive: No

Company Name:
Office of Surface Mining
Project Name, PWS, Permit, Etc.
New Horizon Mine
Sample Origin
State: CD
EPNState Compliance:
Yes p No 0
Report Mail Address: 1999 Broadwa Suite 3320
Denver, CO 80 202
Contact Name: Phone!Fax: Email:
303- 293 -5040 am or osmre. ov
Amy McGregor 9
Sampler: (Please Print)
Key Ag
Invoice Address: 1999 Broadway
Denver, Co e0 zo2
Colleen Zaremba 303- 293 -5045
ottle Order:
Report/Formats
Special Re rt/Formats -- ELI must be notified
prior to sample submittal for following:
cs
>n oa es
e� °)
a
l
d 3C
¢l
v� ?t
, a I �� rte 1 ,
! rs • .�Lr p i) I j' (fit }.,11r , i`il� :l.)
p
U
Q
Q
W
a
;
`
Z
(t
V
contact ELl prior to
RUSH sample submlEtal
for charges and
scheduling — See
Instruction Page
shipped by
Key Ag ii r - &
the
N
1n
0
w
N
i
cooler Nisi:
„ )
`J
[l DW ❑ A2LA
■ GSA ❑ EDD /EDT(Electrorac vale}
Comments:
-ID # 2xxxx
- S amp l e i n t erva l i n
feet; t=xample 15 -20
- Sam locati
A1 B1 ate..
aecelpt Terre
-j- ' o C
❑ POTW/WWTP Format:
on 1Ce:
Yss
❑ State: 0 LEVEL IV
■ Other: ❑ NELAC
custody Seal Y)
Infect Y K
Match re Y N
SAMPLE IDENTIFICATION
(Name, Location, interval, etc.)
Collection
Rate
Collection
Time
MATRIX
I ID # 22103, 85, 35 -37,5
1 -Sail
X
X
X
qflaCqC)35?
' ID # 22107, 86,15 -20
1 -Solt
X
X
X
ID # 22202, 86, 40 -42,5
1 -Soil
,
X
X
ID # 22206, B7, 15-20
1 -Soil
X
X
X
g}
t
° ID # 22210, B7, 35-40
1 -Soll
X
X
X
ID # 22309, B8, 30 -35
1-Soi1
X
X
ID # 22406, 89, 25-30
1 -Soil
X
X
X
° ID # 22407, B9, 30-35
1 -Solt
X
X
X
0
ID # 22408, 89, 35-40
1 -Soil
X
X
X
1
10 ID # 22410, 810, 0-5
1 -Soil
X
X
X
Custody
Record
MUST be
Signed
ReYnqukhed by !Print): Dais/Time. Sign,
Bra. Atw '/ffl /lira 2 ' .,
e:
stewed by (pri A)• Delarrkne Signature:
'gished by it*+): Dalorr,me: nature:
deceived by (prk4)• bale/Time' Stadium
Sample Disposal: Return to Client: Lab Disposal:
p
by r f / ;�7� l
1 v-7 7//Prt/7id g ��� rd: /�
EAERGY
LABC7RA roRIFS
Chain of Custody and Analytical Request Recora
PLEASE PRINT- Provide as much information as possible.
in certain circumstances, samples submitted to Energy Laboratories, Inc. may be subcontracted to other certified laboratories in clyderto complete the analysis requesled.
This serves as notice or this possibility. All sub - contract data will be clearly notated on your analytical report.
Visit our web site at www.enerovieb,com for additional information, downloadable tee schedule, Corms. and links.