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i <br />Operation• ~~n <br />Company/Address: <br />Specialist: I~r•na <br />Date:~Ti <br />Comments: <br />• • Page / of ~ <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />1C 2 y ~~kvnan •~nrJl`' File d~: C-~I-Q7~ <br />~~14..r~~n C..,_1 (~~_ ~aS4c4s r e.fi G'~. 14rA.27 t'i...b~,Mine Contact: ,Q~yi;r!, <br />: /h~~u Weather: <br />r <br />ry: <br />1. Site ID.: ~ O7~ pS 03=S !Q Location: ~,,,_ ~,,,.g ~~10U~ t-i ~~PI ~'irr k~ / />.. %/I~+ ~~f~rrl <br />Full Ground Water/ 1 Sur ace a et/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: ICr~ rmn~Pr./, I Time: ly~~l~ <br />Sample Split: Yrs Comments: 51~~~~ iJ ry~1e.,.r.~t.r <br />t <br />Flow/Level: 3~s0 z~•q3 pH: $•) Temp. 22'C EC. Z$1(J Other: <br />?. Site ID.: 071 B$OSt 25-~ Location: f}rrn `J~ID "~ l CTORSO~ ~ ) '~'inl~~rP I'~.~+. A05~~ P <br />Full Ground Water/Fu1ll Surface Water/Partial Sample~~/Soil/Grab/Composite/Filter7ed/Raw <br />Disposition: (',mn 0 ,1P r.~ /IIrS Time: I~~Op <br />I / f <br />Sample Split: ~ J1/p Comments: lT1P~i~rl ~~r7/~nP w,i/„~ aNU ~~. S~q~ <br />Flow/Level: pH: Temp. EC. Other: <br />\ .~ <br />3. Site ID.: ~~~JSs45USc2tG Location: in 0 Id P'~Z CT.In,P ~ II~~ ./~:r n„„.nns17P <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./ of /Grab/Composite/Filte ed/Raw <br />Disposition: fir. r40h~~ ../ Su ~~S Time: lGi?O <br />Sample Split: N~ yComme nts: ~,?//50~~ ~Sm( ~~vl cr~..t r~,~ <br />~ , <br />Flow/Level: pH: Temp. EC. Other: <br />,. Site ID.:071 FY,Uk•~S R Location: ~~N 9~~p ~r'3 /T;~4sni~~ ~~Jl.,y„ ).r{ <br />r <br />Full Ground 4]ater/Full Surface Water/Partial Sample /Geo.~i~.>/Grab/Composite/Filtered/Raw <br />Disposition: (~,,,,.,.005~~1 ~ <br />Sample Split: llJ~~ <br />Flow/Level: <br />~. Site ID.: <br />Comments: <br />Time: <br />r_ai~l <br />Temp. EC. <br />Location: <br />Other: <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: <br />Temp. EC. <br />Other: <br />~fIAIN OF CUSTODY <br />1. Transferred from: To: Time/Date: <br />1. Transferred from: To: Time/Date: <br />ieceived at Lab by: <br />Date: <br />3934F OOOYRM O DYA <br />