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s ~~~ ~~~~~~~~~~~~~ ~~~ <br />-. <br />. T <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />Operation: ~ A y <br />Company/Address. <br />Specialis,~~:~`~/ <br />Date: 7/22 <br />Disposition: <br />Sample Split <br />Flow/Level•~ <br />2. Site ID.: <br />12 <br />`M~IIfO [q~~e <br />Page Z of Z <br />File /i: (~- 81 - O 77 <br />Mine Contact:, an.r~J <br />ter/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />/~ . <br />~/ C ~ ~~ F-7~C Time: V O~pn~. <br />_, <br />Comments: <br />_pH:~Temp.~EC. ,~60 Other: <br />Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: <br />Sample Split: <br />Flow/Level• <br />Temp. EC. <br />Other: <br />3. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pN: Temp. EC. Other: <br />4. 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 />Flow/Level: pH: Temp. EC. Other: <br />Site ID.: Location: <br />5 <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />CHAIN OF CUSTODY <br />1. Transferred from: To: Time/Date: <br />1. Transferred from: To: Time/Date: <br />Received at Lab by: ~(',Z y[~p1nLy~,r~~, y~~~ Date: ~/~j'$b 1339 <br />8934F OOOYRMODYA <br />N,5 ~9 <br />Comments: <br />