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-. . -tol^'1~ G. ;__;~, Page / of MINED LAND RECLAMATION DIVISION MONITORING FACT SHEET LABORATORY SAMPLES G1 Operation: 5 Me File ~j: ~' O1 ~0~' Company/Address: ow c ,N C ~ {• 1/ 1 2 Mine Con[act:Lorry~',.S,ijc~ Specialist: _~,- T Date: ~ z T me: ~S:pU Weather: Olc.•~ 1~„: Commen s: Laboratory: ~~Sfe.1,.,L..~rS.,.i~f 1. Site ID.: oy1Q$OS7.H /~ Location: (!~pgJkl ~ /h;~v~l~, U.e1~ T -~ 11 Groun a en/Full Surface Water/Eartial Sample/Geo./Soil/Grab/Composite 1Cere /Raw Disposition: ~1~tYft~' 1.CC~ Iw~r^~i.,~t ~y Time: IJ~~D _~ Sample Split: IJC Comments: ~/:t` PNG~111 v,,,~e~ ;N •}„1pt 'Li 4ctilrye 3OD~e {~~,~ Flow/Level: `f ,h ~l' c~-~~~~f pH:7.4S Temp.77•Z EC. 37SD Other: 2. Site ID.:o418$052`~~ Location:_ Full Ground Water ~` 11 Surface a e /Partial Disposition: ~1~e+~•'~ ; scc.~ , rN., /,(;,~}~` _ P \~ 3 Sample/Geo./Soil/Grab/Composite/ alter /Raw Sample Split: /1/~ ~ Comments: 1 ~~11fr~ tt>~ Svl~t ~"~~~~R rt~ h.; Flow/Level: < 1,4 9.A,M, pH:~S1JOTemp. 89.0 EC. $3~/D OtherJJ: Site ID.: DYIPi~O52'1 G Location: CK~ k!I / 7D. 'I Full Ground Walnter/Full Surface Wat1e-r/Partial Sample eo /Soil Grab/Composite/Filtered/Raw Disposition: Y~aC[d~ iln Z`m~~kt' Time: IS:J<) 'Sample Split: Iy0 Comments: Flow/Level: pH: Temp. EC. Other: 4. Site ID.: Uyl$~OS2~n Location: ~r~~~l t# 1 /TC/' //~~ IO,ye Full Ground 4later/Full Surface Water/Partial Sample/ eo Soil/Grab/Composite/Filtered/Raw Disposition: Q~u«~ 1~ Z•1/I~dcF Time: /~:3~ Sample Split: Na Comments: Flow/Level: pH: Temp. EC. Other: 5. Site ID.: Q+{1 RSdt_y ~ Location: CFA }}j ~ ~y Full Ground Wat/e~r/Full Surface Water/Partial Sample eo /Soil/ rab/Composite/Filtered/Raw Disposition: /'~GCP~ iH i1f1IU~<< Time: /S• 3G ^,1 Sample Split: /-° Comments: ' Flow/Level: pH: Temp. EC. Other: CHAIN OF CUSTODY 1. Transferred from: To: Time/Date: 1. Transferred from: To: Time/Date: Received a[ Lab by: Date: 8934F OOOYRMODYA js'30 1 1. i