HYDRO28744

• Permit No: C1981010
• IBM Index Class Name: Hydrology
• Doc Name: MONITORING FACT SHEET LABORATORY SAMPLES
• Permit Index Doc Type: DMG SAMPLING
• Media Type: D
• Archive: No

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Operation: /~(~/
Company/Addre~,` /%
Specialist: ~ /+N~' ~
Date: G' / 7 / ~ "~ Time
Comment's
1. Site ID.: d/!l t
Full Ground Water

2.Pr~
GJ'n~Fi J-,..G
Julf/M Weather:
999
File ~k• C~ Uf!,-~'/ ,~- /
Mine Contact: J•'i'k-/~t
Laboratory: ~' C r
/ 2 4/ ~ /`~ Location: %1~~,,/l1(.,,rn~ ->r/-.<'~,
T- ~'~ ~
~i1~Surface /Water/.Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: f=C~-ir /-I ~ ~ ,~. / ~ Time• ~ `Z /l ~1'
Sample Split: `~~~/~ Con~~e~sir~ 3~~°c{5
/ I~ c
Flow/Level: •9~ip~ .S/,/l"~pH: r3 Temp. y."''r"EC. ~~~~C~IJ Other:
2. Site ID.: /~ Q Osl Z VJ ~ ~ Location: ~~~
1~u11 Ground Wate Full Surfacerr Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: `/(' c/~ /~ C I ~• t~ ~ ' ~-~ Time: i ,~3 (1
Sample Split: ~y~ CommQ~t `` ~~
Flow/Level: ~~.~ "..7,5 ~ pH: c-1.1 Temp. J'" ~'r EC. ~VJ;t~~•1fi`~~~A{Other~
r ~
3. Site ID.: Location: ~
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw I
Disposition: ~ Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. Other:
Site ID.: Location:
Full Ground 4later/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. - ~ Other:
4
5. Site ID.:
Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: - pA: Temp. EC. Other:
CHAIN OF CUSTODY
1. Transferred from:
1. Transferred from:
MONITORING FACT SHEET
LABORATORY SAMPLES
MINED LAND RECLAMATION DIVISION
To: Time/Date:
To: Time/Date:
Received at Lab by: Date:
8934F OOOYRMODYA