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-.. -..+s ~ r ~. _ <br />)peration: <br />company/Address: <br />3peciali t• <br />~ate• Time r <br />~omments: <br />tory <br />1. Site ID.: (~\ ~_Location:_pc~~, ~pZ ~iSC~n ct~~e <br />Full Ground Water ull Surface Wete /Partial Sample/Geo./Soil/Grab/Composite/Filtere / <br />Dis osition: ~. Q ~i~h~Rk Pna, e, n,,. / C„o1~\g~~ H\ ~o.3eAr <br />Sample Split: Comments:~~ ~y.~~ ~on~C Somr Svr„(~le~ <br />Flow/Level: G pH:~_Temp.~ °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/Rav <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other:_ <br />Site ID.: Location: <br />Full Ground 4)ater/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 />~. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition:_ <br />Sample Split: <br />Flow/Level: <br />Comments: <br />Temp. EC. <br />Other: <br />CHAIN OF CUSTODY l Q <br />1. Transferred from: p To: C->Ce,r\l,pn,.J. Time/Date: ~j~7 QK <br />1. Transferred from: To: "`7 Time/Date: <br />Received at Lab by: <br />~' - Page l of 1 <br />}FINED LAND RECLAMATION DIVISION <br />_ MONITORING FACT SKEET <br />`~;,' LABORATORY SAriPLES <br />Fg`~P File ~• ~"Yj1 '( <br />~~ < ~~ nine Contact• <br />• 1.~ A,,,.. ~ Weather: <br />Time: <br />Date: <br />8934F OOOY RM ODYA <br />