HYDRO30717

• Permit No: C1981044
• IBM Index Class Name: Hydrology
• Doc Date: 8/31/1989
• Doc Name: MONITORING FACT SHEET FIELD SAMPLING
• Permit Index Doc Type: DMG SAMPLING
• Media Type: D
• Archive: No

Page ~ of
MINED LAND RECLAMATION DIVISION
MONITORING FACT SHEET
LABORATORY SAMPLES
Operation: ~ ~ ~ ~ '' File lk: ~ ~ ~
Company/Address: ~ ~ "~ ~~~ -~ ~~' ~ Mine Contact:
Specialist: t 'r ;.v~ ~ ~ •
Date: ~ Time: '~' Weather: ~ '~'
Comments: Laboratory: '
1. Site ID.: ~ ",~~~-r. ~'~-.l Location: - " ~
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: ~~ ~'~~ ~ ~l' ~ "' ~ ~ --
Time:
Sample Split: ~ Comments: ~'" ~~
Flow/Level: ~'~ ~ ~ pH: Temp. EC. =" Other:
2. Site ID.: Location:
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:
3. Site ID.: Location:
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 Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. Other:
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: pH: Temp. EC. Other:
CHAIN OF CUSTODY
1. Transferred Erom: - ~ ~~'~ '
1. Transferred from:
To:
Received at Lab by: i
i
~~
Time/Date:
Time/Date:
.,. ~ ~ -z Date:
.;,
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