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~~' ^III IIIIIIIIIIIIIIII <br />999 <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />Operation: Fisrf CLFFX %,pp/r File ~:C-S/'fl36 , <br />Company/Address:~CC- r!J P.OX 997 C]~,(-(i~tGk_(O 8~ Mine Contact: FN)~S~S <br />i <br />SpeCtallst: `7-aEr2,C <br />Date: a//8/g .~ Time: //: 3 Weather: (/~,Q{~ ~//r7T <br />Comments: Laboratory: ~¢~ Z <br />1. Site ID.: p .36 ~ 7n g l~ / Location: /(.(~~ d ^eT ~~ <br />Full Ground Wate /Full Surface Water Partial Sam 1 /Geo./Soil/Grab/Composite Filtered/Raw <br />Disposition: % !{c~ /M~aG~~~t_~g . Time: <br />Sample Sp1it:~Comments: ~~~3 ~l/L//[~ I~JCJ~ a7~ ~0~~ <br />Flow/Level: /b"77 5,9 ~ys/7 PH: 6,9 Temp. /o (o EC. ~¢[~a Others <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/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />4. Site ID.: Location: <br />Full Ground Glater/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 />5. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Commaents: <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 _~ OOOYRMODYA <br />