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r Operation: /(pq~ Company/Address: Specialist:~yY Date:f ~4yI4Sc Commenis:~ . - z1----..-~` ~. I~...~--~' -T.. III III III III IIII III ^ 999 Page ~ of MINED LAND RECLAMATION DIVISION ~'-MONITORING FACT SNEET LABORATORY SAMPLES File /k: ~' p''Oyl r./V RiSZa: Mine Contact:L~sY/n,~,~c~ 15':DU Weather: ratory: 1. Site ID.: o41Si6pS1H Q Location: CIfpA r~l ~ /h~~IC I,vet~ 11 Groun a eu/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite% lter ~/Raw Disposition: (-,(}tY~' .ICro< ~Iw~r.~,„~~`y Time: /S~~V ~ , Sample Split: NO Comments: Alof PMO~~h vw~w .w '~.~o~ 'b7 a~~,'~wP 3C•~~ ~fw,! Flow/Level: ~I,~ I`f ~~~j~f pH;7.4t Temp.7~Z EC. 37SO Other:` 2. Site ID.:04IBg~51`( ~ Location: $ceD ah0,I~ ~ $o~~ S«0 ) ~~iQ~R ~! ~ , Full Ground Water u Surface a e /Partial Sample/Geo./Soil/Grab/Composite/ ilte /Raw Disposition: ~,(~e~~dl; 3c~~ ,;,,c„r,~diHfc~~ Time: lS~317 an,~ ~~ 5~~~,~ ~~~i ~~~ a , Sample Split: /~/~ Comments: 7 h rn, w~ ~ (r~..,~A / a• Flow/Level: 1 I,4 q.p,rW, pH:$+S~ Temp. E9~0 EC. $39U Other: 3. Site ID.: pylQep52y L Location: CR~A d I ~~~~~ 7411 y~ o~ ~e Full Ground Water/Full Surface Water/Partial Sample 6eo.~/Soil/Grab/Composite/Filtered/Raw Disposition: irucra~ l ~ ~ •O~ckt Time: !S 70 Sample Split: ~p Comments: ~~'.~ Flow/Level: Temp. EC. Other: 4. Site In.: 04168os:y ~ Location: C`i(D~ 1¢ I /Top ~ ~,`1P i Full Ground 4lat/Ier/Full Surface Water/Partial Sample/ eo./Soil/Grab/Composite/Filtered/Raw Disposition: r(ac~~ ~/~ Z•y-~JakM Time: /f .3O Sample Split: ~ Comments: Flow/Level: pH: Temp. EC. //Other: ~~ 5. Site iD.: pyI ggas~y ~' Location: rlQ~l~} ~( / ~~ -L !~' I~ - { i c i Full Ground Water/Full Surface Water/Partial Sample G~/Soil/Giab/Composite/Filtered/Raw Disposition: ~~GCp~ Is i,dluck Time: /S•3u 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 at Lab by: Date: 8934E O O O Y R M O D Y A - ., ~' ,. -