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<br />Page ~ of L <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />Operation: ~( ~ rued ~. ~~ 1v\~y~~ File II:_C~ $I- ~t~l p <br />Company/Address: MCA ,U. Q 53~ (•O Siojj Mine Con[act:(h,.:l,~i~~~ <br />Specialist: ~,~ <br />Date: ~I Time: ~~Q o,~, Weather: Lr_~.rrv~ s~ <br />Comments• ~ ~ ~ aboratory.. ~~ir~c~ <br />1. Site ID.:~Y-/ Location:' ._L ~ _"T~~ <br />Full Ground Water/Full Surface Water/Partial Sample Gleo Soil/Grab Composite/ filtered/Raw <br />Disposition:-~~~r,;~cn,~..rs In.I.J.,~NakcQro~-.,,.T[P-~c.~ a~a3. o-... Time:f~:3n <br />Sample Sp1it:~~Comments: I [a.~.pus:~c Sc ~ Slor.,~iz.-, Spl, 1 -F~..k.,, 1~ ~{(~ <br />Flow/Level: pH: Temp. EC. Other:~r'~$.. ~T, <br />2. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite /Filtered (Raw <br />3 <br />Disposition: <br />Sample Split: <br />Flow/Level: <br />Site ID.: <br />-Temp. EC. <br />Location: <br />Other: <br />Time: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />4. Site ID.: Location: <br />Full Ground 47ater/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. <br />5 <br />Other: <br />Time: <br />Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />CHAIN OF CUSTODY / <br />1. Transferred fro ~-....,, To: Time/Date: z/~z~9S n,l`54~~ <br />1. Transferred f m: To: Time//Date: ~~~ 09:00 <br />Received at Lab by: ~~~, ~~~,~„p~~y-~ Date: ~2(23'~S <br />Comments: <br />8934F 0 0 0 Y R M O D Y A <br />o y g 9 ~ o a a I H <br />