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Page I of ~ <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />)peration: Cpl-DES.' ~E~ ~Ilil= <br />~ompany/Address: i,cY'GHiI.;/a FUEL %.'G. zC55 <br />specialist: •'A-•(ES C . SiE~ NS <br />)ate: '2 ~$~ Time: 40'C'CA Weather: <br />:omments: r2Ll../ Sc[l: o.7D 21~rri [:F~F_~fAPl7 <br />File ~k: C- sl-~ 13 <br />~. ~ ~~ C. i5~6 P4 <br />Laboratory: <br />contact <br />t. Site ID.: Ga~N 5'416 kINE Location: ~-CE~fJ,CCLC2JLI7C` <br />.Full Ground a e u ur ace ater Partial Sample/Geo./Soil/Grab/Composites/Filtered/Rav <br />Disposition: 'CEn i N CLCLE~L Time: C 3:aC PN ZIS~ <br />Sample Split: 1~0 Comments: NO FIH.D PAR~AIIETEQS T}4KE3.7, hcT ~'IEL,DC(;LTL'2®~TC• <br />Flow/Level: - pH: - Temp. - EC. - Other: flP2C%X.~1-f2S$E'fu"~IJ <br />TI HE OFCOUKTI^./J D <br />_. Site ID.: Location: FiU <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composites/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. O[her:_ <br />3. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composites/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other:_ <br />1. Site ID.: Location: <br />Full Ground 4later/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flov/Level: _ _pH: <br />i. Site ID.: <br />,Temp. EC. Other:_ <br />Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composites/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Co®ente: <br />Flow/Level: pH: Temp. EC. Other:_ <br />MAIN OF CUSTODY <br />1. Transferred from: JT>='.'DNS To: ~L•Zc:-oNGAA;Y Time/Date: 4~OC I~ ZIS ~~' <br />1. Transferred from: To: Time/Date: <br />2eceived at Lab by: Date: <br />i934F OOOYRMO DYA <br />