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,-""~^,p~ „' -+.rr .~. .-~ .+vs~. ~ fi~^,.~;y./•?~")rfh'-Mr ai+r ~'rx.~~+.-..'i;~"~h.'+!K•~ <br />• • <br />Page of <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />i <br />Operation: (` ~ q - /<.,., ~j "~l File ~i: ~r ~ `~ / <br />Company/Address: Mine Contact: <br />Specialist: (.., .n // JC~C,U..i <br />Date: ~ - ~6~ i~ Time: /; y ) Weather: 0,~.+-~.~./ <br />Comments: Laboratory: <br />1. Site ID.: ) 7„ Location: ~Jci~n C ~.. ~. ,,., ~--'~~ <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: ~ ~"rs-.,L -~I ~ =1 -7 i~CIJ ~ ~; +y•L~ P "'~~~"„' Time: ~' ~ ~'~ <br />Sample Split: ) ~~ Comments: <br />Flow/Level: i~ ) i.n pH: 7~- Temp. ~~, ' EC. ~~ v~ Other: <br />J' <br />2. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />i <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 /> <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• <br />Sample Split: Comments: <br />.5 <br />Flow/Level: pH: Temp. EC. <br />Site ID.: Location: <br />Other <br />Time: <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 />CHAIN OF CUSTODY <br />1. Transferred from: To: Time/Date: <br />1. Transferred from: To: Time/Date: <br />Received at Lab by: Date: <br />8934F <br />1.. <br />O O O Y R M O D Y A <br />