HYDRO27471

• Permit No: C1981018
• IBM Index Class Name: Hydrology
• Doc Date: 12/7/1992
• Doc Name: COMMERCIAL TESTING
• Permit Index Doc Type: DMG SAMPLING
• Media Type: D
• Archive: No

Page 1 of 1
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Company/Address:
Specialist: _~,.
Date: )//i„ 9 '
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NED LAND RECLAMATION DIVISION
MONITORING FACT SHEET
LAEORATORY SAMPLES
1. Site ID.: S OH'f`oZ_ Location: Ic,,~d pv-~
Full Ground Water/Full Surface Watey/Partial Sample/Geo./Soil/Grab Composite/Filtered/Raw
Disposition; 7ccCl .~-• ~. Cac'{-er Time: ly a~-
Sample Split: !~U Comments:
Flow/Level: Q (~5 pH:~Temp. } , }' EC. '$ (• ~(~ Other: ~1°F.;,
2. Site ID.: Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition:
Sample Split:
Flow/Level:
3. Site ID.:
Comments:
Temp. EC.
Location:
Other:
Other:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. Other:
4. Site ID.: Location:
Full Ground 4later/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition:
Sample Split:
Flow/Level:
5. Site ID.:
Comments:
Temp. EC.
Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition•
Sample Split: Comments:
Flow/Level: pH: Temp. EC
Time:
Other:
CHAIN OF CUSTODY ,
1. Transferred from:- ~l~U,~Wi~'n`~S To: .~o, ~ ~!~ Time/Date: ~l-/3-`i1
1. Transferred from: J To: ~ Time/Date:
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Received at Lab by: ~f sy -f . r CLi"~~ Date
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Time:

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