HYDRO29886

• Permit No: C1982056
• IBM Index Class Name: Hydrology
• Doc Date: 9/21/1993
• Doc Name: MLRD MONITORING FACT SHEET LABORATORY SAMPLES
• Permit Index Doc Type: CORRESPONDENCE
• Media Type: D
• Archive: No

y III III III III IIII III
999
Page of
MINED LAND RECLAMATION DIVISION
MONITORING FACT SHEET
LABORATORY SAMPLES
I ~1 i/
)peration: (,(/Pjt~ i~1N.,..~~ l~~ File #: C-~Z ~S (:? ,/j
Company/Address: Mine Contact:
Specialist: /7 ,,.~ _
Date: 9 ZI-~3 Time//?]~,`Z- ~/a~t-~- r7p., //WW_e ther:
Comments: //~~ Q fAT.r>/ S•G.s'IOS ~~TG.~i Laborato rY:
1. Site iD.: on(r~9~~93 Location: cJf~ 30/ ~T~
Full Ground Water/Fu1L Surface Water/Partial Sample/Geo./Soi
Disposition:
Sample Split:
Time •~~_
Flow/Level : 5, ~j pH :jf.(p Temp, j EC. ~U(""""/~j,t.Other:
a i
f
-
R
T~
f
~
(~ l
~
Site ID.: 00209Z/
.3 Locat
on: ~k/y~$~
y
Q?,,,~
U~
-
DZ~
d
~/~
.
Full Ground ldater/F
u 11 Surface [Ja[er/Partial Sample/Geo./Soi G a omposite /Filtere / aw
/
Disposition: C./ItIf-~ Time:

Sample Split : / Comme nts: ~~
Flow/Level: /
y~.LS-l7 pH :~~Temp.~~~
EC. 9 L^"~°S O hh
er:

Site ID.:
~~j~fy/~f 3 ~/
~
~
Location: S f'C ~~3 0>. ~~
Full Ground l
l Surface
Water/Fu Water/Partial Sample/Geo./Soil rab Composite/Filtered aw
/n
,
Disposition: l~ Time:
Sample Split : Comme nts: ~y0
Flow/Level: /
~. Z f~fiL LoH :~~Temp. ~7o~EC. ~ /pv her:
Site ID.: Location:
2
3
4
Full Ground 4later/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split:
Flow/Level:
Comments:
Temp. EC.
Other:
5. Site ID.: Location:
Fu11 Cround lJater/Full Surface tJater/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition:
Sample Split:
Flow/Level:
Temp. EC. Other:
CHAIN OF CUSTODY
1. Transferred from: ~j.'a-.~ To: Time/Date:
1. Transferred from: To: Time/Date:
i
.,-
Received at Lab by:' ., - ~ - ~ -~ ~ ate'~+c •- +"CYM~.. -.~m.~
Con mon of Samples Upon Receipt
Rv ACZ Laboratories, Inc: 7
8934E _ TrmperatureofContenty: °'~ Oe~ Y R M O D
CiML~ - ~ eContainen:
` y saph:
Time:
Comments: