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• ~~ <br />Page of <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />Operation: W(,1,Y.()VJ <br />Company/Add redress: -~ <br />Specialist:_~-~ <br />Date: ~1711191n Time: <br />Comments ::"~-"~- <br />Weather: <br />oratory: <br />1. Site ID.: (-'(~ Location: E~'- <br />Full Ground Water/Full Surface Water/Partial Sample <br />Disposition: ~}),yL f1+('Dr- li/IAhL't( <br />Sample Split: /~/() Comments: <br />2 <br />/Soil/ rab Compoccsite/Filtered/Raw <br />.,(, Y!)'LTK. SJ Time: ;~:,~~,m_ <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: Time: <br />Sample Split; <br />File kk: C- p ~'~~-I <br />R~~pyl Mine Contact: <br />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: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />Site ID.: Location: <br />Full Ground 4later/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: _ _ _ _ Time: _ <br />3 <br />4 <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 />5 <br />Disposition• <br />Sample Split: <br />Time: <br />Flow/Level: <br />CHAIN OF CUSTODY <br />1. Transferred from: <br />1. Transferred from: <br />Other: <br />To: Time/Date: <br />To: Time/Date: <br />Received at Lab by:~~_// ~, Date: 3~a?~96 <br />Comments: <br />Temp. EC. <br />8934F 000YRMODYA <br />