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T <br />• ` <br />• ` III IIIIIIIII IIII III <br />999 Page of <br />MINED LAND RECLAMA'CION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />Operation: 1R/N/>1An l3AJ/N />1/rvrn/ti- Ct+/r,P.v.~./ File /k: ~-$/-Ot/g <br />Company/Address: /•/C-R I, Pa. fSaX IC, Bert BeuRVei..L ~ fee-_._rr'u c1cV /0906 Mine Contact :GAG LEwlckl <br />Specialist: ~oE L~liAg.S`1/ ~ <br />Date:y 2z L Time: `j; ;3p Weather:C /~,Q IND <br />Comments: ow /QE -o Laborat ry: Co~v7Rgc7` <br />1. Site ID.:oyg9a~yao1 f~ Location:_ PoNO a.a-P/~ <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/G_,_ab/Composite/Filtered/R`w <br />Disposition:SoVT// SIDE /h!A-DcPTIJ /C:6~ Time: O93A <br />Sample Split: NO Comments: lNy7'~ CLOprJ.j,y <br />Flaw/Level: fRom Pool pH:~, t Temp.53_/ °F EC.336r(,cS~cn, Other: <br />2. Site ID.:OHB`~204aa Q Location:_ PoN[> IS- Pao <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/G~/Composite/Filtered/Raw <br />Disposition: SOVTiYE/1,ST SidE /h 10 ,06PTil /cEL) Time: /O '. /,5' <br />Sample Split: /1!p Comments: I*/AT61Z So/nEyvN,y-r• CLot~Ali <br />Flow/Level:fRorn Pool, pH:8.6y Temp.S8.3°FEC. ,3gq Other: <br />3. Site ID.: OI/$q~DI/.Z o1 C Location: I ONL) l.s- Pg <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Gab/Composite/Filtered/Raw <br />Disposition: WEST SIDE /SID ~6PTt! ICED Time: //; 00 <br />Sample Split: No Comments: WA7f2 A 4-I'TLE Ctoyol/ <br />Flow/Level: 1r72on, Pool pH:Q.zB Temp.65.7 EC. als Other: <br />4. Site ID.: O 489 oZ D 4aa D Location: p„ N,p I S- P a <br />Full Ground 4)ater/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: So~TN .sldE /h111 DEPTiI /CEn Time: //; Y-~ <br />Sample Split: No Comments: WA7612 A L.i-rnC£ CC.ovov <br />Flow/Level:a~BE[uw fklmnw/ PH:8.g5 Temp. 6,,_ EC. a.~5 / Other: <br />5. Site ID,: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Ceo./Soil/Grab/Composite/Filtered/Raw <br />Disposition:_ <br />Sample Split: <br />Flow/Level: <br />CHAIN OF CUSTODY <br />1. Transferred from: ~~p To: <br />I. Transferred from To: <br />Received at Lab by: <br />Comments: <br />Temp. EC. <br />Time: <br />r: <br />(./1(j Time/Date: ~/'s2/y2 ~/ p~ <br />Time/Date: <br />Date: <br />8934F O O O Y R M O D Y A <br />