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o~' _ Operation: ~L1 ` Company/Address: Specialist: 1 Fv~~ Date: S ~ilRn Comments: t III IIIIIIIIIIIIIIII File fl: ~' ~)" ~~ IQ~-N C~. • 2). (~~ f vtk (1? ~rrir.7 Hine Contact i"^ I s„. Co f yr1 Laboratory: /}( Z 1. Site ID.:~.,rr~E o71~R~~~ F~ Location: ~,n,E lw•..} r~ 4.TL-: ~ A/( ~, c, Full Ground Water/Full Surface Water- a /Geo./Soil/Grab/Composite/Filtered/Raw/ Disposition: Sw~.Dlt l~P''~ i„~,r•,~~„~r~v 1 Time: 12';~n~^•rnnr//~~ Sample Split:~~~C Comments: Dne-a~./ f ~«~..~N ro „,,, 1. ~ ~ Flow/Level: , Vg71 c.t•,S. pH:6,50 Temp. ~B ~ EC. ZS ~ Other: 2. Site ID.:Fa.l[~~~O71EBd-~1) (7~ Location: Fu',.I[~ ~r~tk S~Cf~~ Sr~200~ Full Ground Water/C~ull Surface Wate .Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw Disposition: ~.~.(I~t i(r~ I.mW~r.~'.,~.~y Time: 1~~~~~,r r~.~y/,~~1 Sample Split: ~r5 Comments: qDu,~ rrr~i~°~~ ~"~w S~.~DIP _..~. ~.-_..,.. - I ~ Y r Flov/Leve1:5~.~{swC[= ~+72 pH\:7, Temp.Sq,S EC. 23y17 Other: 3. Site ~ ID.:~SbCyr~~ 1O0j~O71~RP511 H I Location: F'iS~+CrCtk : ~~N~ i~ ~D~~ Full Ground Water a Wat artial Sample/Geo./Soil/Grab/Composite/Filtered/Raw Disposition:~~t lc[ ~ :_' i„•,rr,.~.„~C~4 Time: 2:~/(} omr~v~ - ~ 1 f , Sample Split: ~ ~c Comments: Q'lo-,.}~ V~rti~fc~ vim,.- SF,~o1f Flow/Level:s~~r'' he"rn ~r, •~ •n-! H: „ Tem c P ~ p- Sq EC. ~'7L/ Other: +. Site ID.: ~ Location: Full Ground Water/Full .Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw Disposition-- Sample Split: Comments: Time: Flow/Level:- pH: Temp. EC. Other: ~. Site ID.: Location: Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw Disposition: Time: Sample Split: Comments: Flow/Level: pA: Temp. EC. Other ::RAIN OF CUSTODY 1. Transferred from: To: Time/Date: 1. Transferred from: To: Time/Date: 2eceived at Lab by: y„Ji %~.~!.:~.:U,'-~JG Date: ~ j%/j 'L~ 7. ~,~' ,~ U --: - MINED LAND RECLAMATION DIVISION MONITORING FACE SHEET LABORATORY SAMPLES / t= Page ? of Z 9934F OOOYRMODYA