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<br />q. ~-.' `~. ,~~~ ,: <_ MINED LAND''~RE'CL:4MATION DIVISION -.
<br />MONITORING~FACT SHEET.' ~:?'"
<br />. ` LABORATORY. SAMPLES `~ `' "sF.:.
<br />Operation:.IAP./T,.r /fi~ro.. ~iv r Nv++/rl+r ''#~ File ~: C- b'/" D,
<br />Company/Address: 4, ~. Mine
<br />Specialist: B >w ' ~. We /f-r-.~
<br />Date:/3J:v 4 Time: /y~/3 Weather: C/~,,,~ worwr
<br />Comments: ;~cAC,. ~ Laboratory:
<br />Composite/Filtered/Raw
<br />Time : / = ~ =~
<br />.: a.
<br />1. Site ID.: M,4,t,~ D(, / ~ /4 Location: S~~iK,,,~ /~_NC/ /~; rrLu>q ~
<br />Full Ground Wate /Full Surface Water Partial Sample/Geo./Soil Gra /Composite/Filtered/Rawt
<br />Disposition: S-t+.~ ~1 /+.~ nYGr. c ~u f/~i. S Time:
<br />Sample Split: /yp Comments: (0<~,1~,...~'fi ,,,,'~Gr /fi.rr, Lpw•~~1 ~ +
<br />/ Flow/Level: yo g~,,,, pH: B, / Temp. [y.f' EC: Other:
<br />2. Site ID.. iL(~f A[ u G l ~ /-i Location: /~, /r~. ~/;,.., , ,,,. ,/ „} ~-, /~ „~ ,,, ~,,.,/,,,, ~/
<br />Full Ground Wateri[Full Surface
<br />Disposition: fx,.Y
<br />u C
<br />Sample Split: /1~,: Comments: %r4.•~/ w../ ~i ~~~
<br />Flow/Level: ~~ s., pH:fi'.j `f Temp.~~EC. Other:
<br />3. Site ID
<br />Location:
<br />Full Ground Water,~Full Surface Water/Partial Sample/Geo./Soil
<br />,~
<br />Sample Split: .^~ ~- ~ Comments: ~~,,-~' 4,..1 ~~~.:,
<br />Flow/Level: :~~ (•'~~~+ l'~..(r ) pH:~_d'emp.~~EC. Other
<br />4. Site ID.: Location:
<br />. ( '~
<br />~ .'4114
<br />Page : of `'
<br />:~~~ .:
<br />"~
<br />e/Filtered/Raw
<br />Full Ground 4later/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
<br />Disposition•
<br />Sample Split:
<br />Flow/Level:
<br />5. Site ID.:'
<br />Time:
<br />Comments•
<br />pH: Temp. EC. Other:
<br />Location:
<br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
<br />Disposition•
<br />Sample Split: Comments:
<br />Flow/Level: pH: Temp. EC.
<br />CHAIN OF CUSTODY
<br />1. Transferred from:
<br />1. Transferred from:
<br />Received at Lab by:
<br />8934F
<br />li.(.Woll~.1~ To:
<br />To:
<br />ial ~uample/Geo./Soi
<br />Time:
<br />Other:
<br />Time/Date: 1 ~ S' 'r ~ i ~ J ~~+ 7 /
<br />Time/Date:
<br />Date:
<br />O O O Y R M O D Y A
<br />/~" ~ ~ ~ / (~ Qom, ~.~~
<br />/
<br />
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