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<br />me: or.:
<br />°?~~ •.-'~;9.:'Does- Mine ~Represer
<br />~~,r '~ 10.' If so, h~~SSst riame-
<br />;~: •'r '. Does they Operator
<br />' ~~. ,r_ r 13:. Arethere~enyasp~
<br />"`="' 1;4.. Parameters` to be.
<br />• r ., ~ "_ Temperature ~ ,
<br />" - X15:_ Type Hof Sample:.
<br />_ taken- ,VP s"4
<br />y, Pfc
<br />.; -- ~16.. Containers::
<br />:~:;,>:-',Y,~17:, Name &: Tt~Tt e of
<br />_ 18. .Was sample split
<br />19.. Who Received or-
<br />- - .. ~h,,;,~.
<br />20. Disoosition of s
<br />ki:ve=;wish'to;;be.present?::L.ytr~~=~:°•w•=~~~'~ ~'k~M
<br />, ,
<br />it9ye•;-, and-phone ~ ~ -- ''~^~
<br />ish~,a:samp a sp, it?.•. N~ •- - -=-=~>_ `~'RInitia s
<br />rov.ide container,?,*'.'° nip r ~~-^~ ~.Ihitial's
<br />,.1 ~'•'~`..r....... on*e~t n. moa* at e7YP-~~'" ~"~:
<br />amp
<br />c:.contamers:w/o acid ,~,:r=<•~,: ;=
<br />c: containers acidified w/HN03:~r":
<br />ea~:': ~- ~ .r.ir~~' ii ~ir~
<br />d:`%.;Total Suspended Sol ids. •s-
<br />eabl'e Solids '' 4Iron • _~z~ :F~.
<br />Composite .= Descr.i [e.~ eocat.
<br />r" 00.7 ' ,~ '~':,'<ONfM7P "/Jlif%RMIP ~f'
<br />
<br />During
<br />sent,
<br />P.re Samp ~ng:_ ,,-~;,.-.
<br />--,.~;.~a:.:r.;;....,-~,:.-.,;~,
<br />.
<br />1
<br />nMOf 9NI SOr+//0 I/S~ ..t;r,.~, .-~.
<br />~ ,
<br />,r... •, .ypLy~'.
<br />r _..«
<br />;: ~,.,: ear .
<br />'
<br />,
<br />Spit Name, it e,: nitia s :. ,,W .a.: •.
<br />,
<br />.._,...;
<br />'
<br />ection
<br />ifter• co :; - YL~.y/ .~_~rP ~- ia~kr ~ae~
<br />' nc*r+d /~PkuP,x~ •-'fa von roc a.
<br />• - - Transferred From:,. er.v-=-'Ro~7frr- o:- Shar
<br />_ _ 7ransferred'From:c ~~. .- ~ To:.
<br />-~ ~ Transferred-.Fromr - ~ • -- •• - Toe: -
<br />_ Transferred From:• o~
<br />Received at Lab by:
<br />Comments•~.
<br />,ime. ate:: 'ySP~' ,3v~9~
<br />Time/Date.:.` G _^ •:
<br />Lime/Date.:,:--~~ '.
<br />Time/Date •. '
<br />Time/Date:.
<br />_- _--.-. No e:-~ --Laboratory ana ysis o .t e a ove mentione Samp a in ica es a-,
<br />-'•^_ ~ _-_- violation of:,the-"Water Quality-Control-Act", or- other-State-or-Federal water._:.
<br />quality Laws,, these results may be used in the future for enforcement actions.
<br />^-` Signature of_":Sampler'::'' ~-,2.~%~~'~ •'~°'•I -- -
<br />_ _ ,,.
<br />---- -
<br />-. ;. . - :.
<br />~~ i _
<br />
<br /> s~~~
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<br />Q,r , ri:rr ~ , .-
<br />r'.' 2,/~
<br />
<br />Rv ~ •~°
<br />was-:- ~ , :,c.=
<br />a,.y ~ .;; ~~::
<br />„-,;- -
<br />DEC " ~ 19-'l
<br />~" - Mined Land
<br />Reclamation Division
<br />
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