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~ III IIIIIIIIIIIIIIII ~ <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />Operation: <br />Company/Address:` ~ <br />SpeLrialist: <br />Date: Time: Weather: <br />Comments. <br />1. Site ID.: ~32~i3-1Q~Q~iZ Location: <br />Full round Water Full Surface Water~Partial <br />Laboratory: .,pG-L <br />/Soil/Grab/Composite/Filtered <br />D.~ppsition: ~~_ W}~~n'7~ Mi~i1fPJ Time: ~'1,5 <br />X Sample Split: ~d Comments: <br />II Flow/Level:~)~ pH:Q~~Temp. q~G EC.~~ Other: <br />2. 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 />3. 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 />4. Site ID.: Location: <br />Full Ground 4later/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 />5. Site ID.: Location: i <br />1 <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. <br />CHAIN OF CUSTODY <br />1. Transferred from: To: <br />1. Transferred from: To: <br />Page 3 of ,3 <br />File dk: ~- R~-a3~'j <br />Mine Contact:_~~i ~_ <br />Other: <br />Time/Date: <br />Time/Date: <br />Received at Lab by: Date: <br />8934F OOOYRMODYA <br />