Laserfiche WebLink
_ .. ~ <br />~ _ i <br />Page of <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />Operation• File ~: <br />Company/Address: '.' Mine Contact: <br />Specialist: <br />Date: Time: Weather: <br />Comments: Laboratory: <br />1. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo.~Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />2 <br />Sample Split: Comments: (, ~ ~~ <br />Flow/Level: pH: Temp. EC. Other: <br />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: pH: <br />3. Site ID.: <br />-Temp. EC. <br />Location: <br />Other: <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 />4. Site ID.: Location: <br />Full Ground 4later/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />5 <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />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: pH: Temp. EC. Other: <br />CHAIN OF CUSTODY <br />1. Transferred from: <br />1. Transferred from: <br />Received at Lab by: <br />To: Time/Date: <br />To: Time/Date: <br />Date: <br />8934F OOOYRMODYA <br />