2012-07-27_HYDROLOGY - M1977300

• Permit No: M1977300
• IBM Index Class Name: HYDROLOGY
• Doc Date: 7/27/2012
• Doc Name: TECHNICAL REPORT
• From: MTN STATES
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

A. CCIJTEST
Accutest Job Number: D36098
Data / Time Received: 7/3/2012 1:40:00 PM
Project: SCHWARTZWALDER MINE
Cooler Security
1. Custody Seals Present'
2 Custody Seals Intact'
Cooler Tem oerature Y or N
1. Temp criteria achieved: © ❑
2. Cooler temp verification: Infared gun
3. Cooler media: Ice (bag)
Quality Control Preservation
1. Trip Blank present / cooler:
2. Tnp Blank listed on COC•
3. Samples preserved properly:
4. VOCs headspace free:
Comments
Accutest Laboratories
V [phone]
LABORATORIES
Y or N
® ❑ 3. COC Present:
© ❑ 4. Smpl Dates/Time OK
Y or N N/A
❑ ❑
❑ ❑
2 ❑
❑ ❑ ❑O
Accutest Laboratories Sample Receipt Summary
Client: COLO. DIV OF REC. MINING & SAFETY Immediate Client Services Action Required: No
No. Coolers:
Y or N
© ❑
© ❑
1
4030 Youngrield Street
F (303) 425 -0854
Airbill Vs: HD
Sample Integrity - Documentation
1. Sample labels present on bottles:
2. Container labeling complete:
3. Sample container label / COC agree.
Sample integrity - Condition.
1. Sample recvd within HT:
2. All containers accounted for:
3. Condition of sample:
Sample Integrity - Instructions
1. Analysis requested is clear:
2. Bottles received for unspecified tests
3. Sufficient volume reed for analysis:
4. Composlting instructions clear:
5. Filtering instructions clear:
Client Service Action Required at Login: No
Y or N
© ❑
© ❑
© ❑
Y or N
❑O ❑
® ❑
Intact
Y or N WA
0
0 © ❑
❑ ❑ I21
Wheat Ridge, CO
www/accutest com
D36098: Chain of Custody
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D36098 ` " ° ° '”° °' °•