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,~ <br />s <br />Operation: <br />Company/Ad <br />Specialist <br />Date: ~,~a <br />Comments: <br />ss: <br />T <br />I <br />File ~k: fj ~-QcJ~ <br />Mine Contact: ),n <br />Weather: ('lour ~ ~nl <br />ry: <br />Page of <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />1. Site ID.: ~y~ `~OOSU~~} Location:Sp~ ao~~acenl ~ Sot Sncp SPU1~~ )/) CGn1Y-lle~J.~ I <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw i <br />Disposition:-Trr'~1 ...~~~n 7d /1nn`I~~~ Time: ~9':3(~ <br />Sample Split: Comments: <br />J <br />Flow/Level: pH: g ~ Temp. S ~ EC. ~} Oy Other: <br />2. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: \ Time: <br />Sample Split: <br />Flow/Level• <br />3. Site ID.: <br />Full Ground Water/Full Surface <br />nts: <br />Temp. EC. <br />Other: <br />Location: <br />er/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: \ <br />Sample Split: Comments:_ <br />Flow/Level: pH: <br />Time <br />4. Site ID.: Location: <br />Full Ground 4later/Full Surface Water/Partial <br />Disposition: <br />Sample Split: Comments: <br />Flow/Level: pH: <br />5. Site ID.: <br />Temp. EC. <br />ation: <br />Other: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil rab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: <br />Flow/Level: <br />Temp. EC. <br />n <br />CHAIN OF CUSTODY <br />1. Transferred from:~fE~FClAP7UNTo: /1 L~ Time/Date: s/,C t?N IVMAv 90 i <br />`1. Transferred from: ~ To: Time/Date: <br />Received at Lab by: ,, Date: //~ `L9q/ $~p S, ~S ~~.y~ <br />--~ <br />EC. Other: <br />i <br />;. <br />le/Geo./Soil/Grab/Composite/Filtered/Raw <br />Time: <br />Comments: <br />8934F OOOYRMODYA <br />