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: CO
EPA/State Compliance:
Yes 0 No
Report Mail Address: 1999 Broadway, Suite 3320
Denver, CO 80202
Contact Name: PhonelFax: Email:
Amy McGregor 30293 -5040 amcgregor @osmre.gov
Sampler. (Please Print)
Ke A
y 9
Invoice Address: 1999 Broadway, Suite 3320
Denver, co a0202
invoice Contact & Phone:
Colleen Zaremba 303- 293 -5045
Purchase Order.
©uotelBottte Order.
Special Repott/Forfnats — ELI
prior to sample submittal for
• DW ❑
• GSA •
❑ POTWNVWTP
must be notified
the following:
A2LA
EDD /EDT(Electronic Data)
Format:
Via,, ii_`� '_,W.'711!`.47. lr�l�'r��l»jl >`�;i ±�L'L!i�
p
la
U
Q
Q
W
W
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$
$
a
z
R
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Contact ELI prior to
RUSH sample submittal
for charges and
scheduling — See
instruction Page
shipped by'
Key Ag
g2 -1
> OI
S TA R .
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CO
Ts). .
Comments:
-ID # 2xxxx
- Sample Interval in
feet example 15 -20
- Sample location
Al, 81 etc..
Receipt temp
/ e U C
On ken
Yes
• State: 0 LEVEL IV
❑ Other: 0 NELAC
Custody Seal Y
intact Y t7'
signature Y N
Match
SAMPLE IDENTIFICATION Collection Collection
Name Location, Interval etc. Date Time
MATRIX
ID # 22808, C7, 0 -5
7
X
X
X
- IQ6‘10
z iD # 22810, C7, 1 0-15
oil
X
sl
3 ID # 22902, 07, 20-25
1 -Soil
X
X
■.�■■$
I X .
ID # 22905, C8, 5 -10
e ID # 23007, C10, 0-5 _MI
ID # 23101, 01, 3Bucket IIIIIIIIIIIIII
' ID # 23103, 01, 9Bucket
1 -Soli
1 -Soil
1-Soli
1-Soil
NOM
X
Ord
a
a`US
` ■�■ � `■■ Q. 9
Ill III X
?
III
r ■. 0
■. X
3 bucket is the interval
L.
bucket is the interval
e ID # 23207, E2, 15 -16
1 -Soil
III X
(...3)
9
X
yo
Custody
Record
MUST be
Signed
e nquithed btlerthle. �:
Zr, 4.1 frLv, v , `/4,4OJ Z- .�:.3�r 1 .+ l . ►
signature:
Sample Disposal: Return to Client:
Re ngtished by (print):
Daten'ine:
Lab Disposal:
Received by (pill):
Date7'fvnr.
Signature'
Received by geinty
naartime:
Signature;
fr77 ,:a7ZM aKr - t -M-4°
tees
16
Chain of Custody and Analytical Request Recoru
PLEASE PRINT- Provide as much informati as possible.
• —a
In certain circumstances, samples submitted to Energy Laboratories, Inc. may be subcontracted to other certified laboratories in order to complete the analysis requested.
This serves as notice of this possibility. All sub- contract data will be dearly notated on your analytical report.
Visit our web site at www,eneroviab.com for additional information, downloadable fee schedule, forms, and links.