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Page / of / <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES G <br />Operation: 5 ~ M2 File 4i: ~~ p''Qyl <br />Company/Address: owe ,~r C p 3Q ~' ,~ i 2 Mine Contact: <br />Specialist: „~; <br />Date: 2 T me: IS:OU Weather: Olr~~ /I,,.„; ,,.~ <br />Commen s: Laboratory: A'C2 /Sfeu.,l....-i <br />1. Site ID.: o91RBOS7.H 14 Location: (!apl}#~ ~ Il1~cI~I~, li+el~ <br />--i <br />.,11 Groun a e++/Full Sur11face Water1/Partial Sample/Geo./Soil/Grab/Composite here /Raw <br />Disposition: F,~Y~+rd~ 1.CC~1 Im-+~i.,~r~y Time: /$~~0 <br />~t Sample Split: /I~C Comments: ~J_^~ PMG~~y~ vtiie~ ;,, ~}„~pt '~ acl,:use-' <br />Flow/Level:'i,ry ~} c~4.r~t~ pH:7~4S Temp.77•Z EC. ~SD Other <br />2. Site ID.:py~BQ052`~ Location: 5~ ~~C <br />Full Ground Water ~ull Surface a e /Partial Sample/Geo <br />/Soil/Grab/Composite/ alter /Raw <br />Disposition: ~lre+~ ~ St~~ „MN,Pdi~n}e~~, Time• 1/~ : jQ <br />Sample Split: /VO Comments: -"~I~f~ ~rvn~ Svr~t ~~+{~~!•5 m, N,;,r~~n~~ ~r~._{/1 4/rM. <br />Flow/Level: < (.0 ~,m, pH:$~$0 Temp. Ff9.0 EC. $3yOyO ~Other~: <br />~- Location: CIS #I / lO `' <br />3. Site ID.:O`IIQi~O52`1 <br />Full Ground Wanter/Full Surface Water/Partial Sample eo /Soil Grab/Composite/Filtered/Raw <br />Disposition: ~~rncro~ i,n 2~dlfic.lC} Time: IS;dD <br />Sample Split: NO Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />+. Site ID.: OyJg~US2y n ~ Location: C'`6~~~{ ~$ ~ f ?3/~ ~ IO,~e <br />Full Ground 4later/Full Surface Water/Partial Sample/ eo Soil/ rab/Composite/Filtered/Raw <br />Disposition: ~juceu{ ~n z.Jlldc~p, Time: /f':3~ <br />Sample Split: ~.~ Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />5. Site ID.: C41 QS~1~Ly ~ Location: Ch j#j ~ ~y <br />Full Ground Water/Full Surface Water/Partial Sample eo /Soil/ rab/Composite/Filtered/Raw <br />Disposition: <br />Sample Split: <br />Date: <br />Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />CHAIN OF CUSTODY <br />1. Transferred from: To: Time/Date: <br />1. Transferred from: To: Time/Date: <br />7eceived at Lab by: <br />3934F <br />Time: /S~ 3G <br />O O O Y R M O D Y A <br /> <br />