HYDRO26404

• Permit No: C1981025
• IBM Index Class Name: Hydrology
• Doc Name: ENFORCEMENT MONITORING FACT SHEET
• Permit Index Doc Type: DMG SAMPLING
• Media Type: D
• Archive: No

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MINED LAND RECLAMATION DIVISION
MONITORING FACT SHEET
LABORATORY SAMPLES
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Comments: T.ab arnrve
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i 1. Site ID.: Y~,r ;,', H'~> „, ,,( , 1 ~ /;,.;Location: (n/ ~, ( f?~ ~ }?I
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Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: ~11~~Fh ,.lY' i'.~D X Y1;!A~r'~ ~ I ~?i'i/~ Time: /(; ('~,
Sample Split: ~)!) Comments:
Flow/Level: L~ - ~iir Y` pH: Temp. EC. Other:
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Sample Split: J0. } Comments:
Flow/Level: ~l~ -'~n(7'1 pH: Temp. EC. Other:
3. Site ID.: ~ Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
^'°F`low/Level: pH: Temp. EC. Other:
4. Site ID.: Location:
Full Ground 4)ater/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
~ Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. Other:
5. Site ID.: Location:
s-a'.
' Full Cround Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition:
Sample Split:
Flow/Level:
Temp. EC.
Other:
CHAIN OF CUSTODY
1. Transferred from: ',~,'~ ~ ~' To: Time/Date: t
1. Transferred fro ~-~To: Time/Da^^te~~,,:
Received at Lab by: ~ j Date:Tl`!~J
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Comments:
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