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____`".- - _ Page ~ of.~; <br />~~~~:'^`~_ `~.; ` - - MINED LAND RECLAMATION DIVISION ~- ~ - - <br />- -.. r~., ._ - _ - <br />?'' ~ %~- • ' - MONITORING FACT SHEET ~ - <br />'~ ~ ~ ~ I <br />.- . <br />_ . - ..., .:. LAEORATORY SAMPLES .. <br />Operation:-` -`7w,~ 'P~;•1 ~ ~./~~,c? ~ .. .File'll: r-~3-~i~C <br />Company/Addressr R,. r,:7 r7-.rvilC I"J ~l%'l S' ~ Mine Contact:r'Iv.r /r'~1' <br />Specialist:. -1 '.r„ rr~„7Tr. <br />Date: -11~:9i~?o Time: fr:SS n~+ Weather: <br />Comments :•= = Laboratory ::" \ <br />1. Site ID.: ~'j Sx 9 J ~`l ~i"? ( • Location: NP-F~ •i/~r. ,~f ,79~ i 6=~i(t SP~ c~.,.1~ <br />Full Ground Water/Fu ].1 Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: ~c.>..~/•, ~r•,/ .+,7 ~,,,,,7 rd.` <br />Flow/Level: • ~. ~ ~ i'M pH: Temp. EC. Other: <br />2. Site ID..: <br />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 />3. Site ID.: <br />Time: <br />Comments: <br />Temp. EC. Other: <br />Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition :_ <br />Sample Split: <br />Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />4. Site ID.: <br />Location: <br />Full Ground 4later/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />5. Site ID.: <br />Location: <br />Time: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition:_ <br />Sample Split: <br />--- Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />CHAIN OF CUSTODY <br />Time: <br />1. Transferred from: ^, r: ~: '~~~:~^ To: ~ J! L !.' ~ti"1 Time/Date: I,g:.~tiS~~~'.~ "/ I l I~x11 `7~% <br />1. Transferred from: To: Time/Date: <br />Received at Lab by: Dater +0•- + _ <br />DEC " ~ '._ _., <br />Time: <br />8934F Mined Land O O O Y R M O D Y A <br />