2012-12-21_HYDROLOGY - M1977344

• Permit No: M1977344
• IBM Index Class Name: HYDROLOGY
• Doc Date: 12/21/2012
• Doc Name: September 2012 Groundwater Monitoring Report
• From: Holcim
• To: DRMS
• Permit Index Doc Type: Hydrology Report
• Media Type: D
• Archive: No

,ADZ Laboratories, Inc.
77 Downhill Drive Steamboat Springs, CO 80487 8
2 3 Do 0 ve ( ) 334 -54
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Name: LI,,.KUM
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Address: I,Ao,�,1 COLS 1�
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Company: ■ t5 'V
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TelephoneWniat_ 5 e -,,,,31 1 3 Jan) ;
Name: 111, M '
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Company: vV,.
Telephonedtol ' .3QIs,)
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Name: i. C.{. 'J • A
Address: ' t U1
Company: i , •
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If sample(s) received past holding
analysis before expiration, shall ACZ
1 1 'NO" then ACZ will contact client for further Instruction
, n dicated, ACZ will proceed with the requested analyses.
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ol i5� r? • • `4roji
Telephone:h 14I3 at • r
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time (HT), or if in Icient remains to complete YES
proceed with requested short HT analyses? NO
If neither YES' no' NO' fir./ , N ` � `' mo ��t
even if Hl is exp.ed and data will be quaufed Y �� •' T• •
{•
y `+ u ��t
Are samples for SDWA Compliance Monitoring? Yes U No
If yes, please include state forms. Results will be reported to PQL for Colorado
Samplers Name: 0 t 1 J1 Sampler's site Information
Quote #: /kAW - 1- t1T
State CID
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Zip code
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Time Zone
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Pro ectlPO # : : r-Z 10 a ODte
Reporting state for compliance testing: ^ , ` o ►- r
C heat box if samples indude NRC licensed materiel? U �- , a
KAW r
11111111111WAVAI &aft _
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Matrix SW (Surface Water) • GW (Ground Water)
Please refer to ACTs
• WW (Waste Water) • OW (Drinking Water) • SL {Sludge) • SO (Soil) • OL (0d) • Other (Specify `
terms & conditions located on the reverse side of this COC.
i' r •
FRMAD050.02.11.11
White - Retum with sample. Yellow - Ret4lft for your records.
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