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.,,~, ,, , ~ , Ill Illllllllllll III <br />~._.;b~``: ~,MI_NED LAND RECLAMATION DIVISION <br />_,t,-~ .~-,~,~-,r.,i,, +.,,.,, MONITORING FACT SHEET <br />LABORATORY SAMPLES <br />Operation• /\ UGC <br />Company/Address: ~. <br />Specialist: ~ n <br />Date: `f~~ S c~~. Time: <br />Comments: <br />Weather: <br />Laboratory: <br />1. Site ID.: Q~~q(;L'?cj-~Ci! Location: L`u.~r fie'"I` c..if~c~a' <br />Fu 11 Ground Water/Full Surface Water/Partial Sample Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />P P 1 ~ < :.~ ~./u. "~ ~ ~J C~." 4e.~~c'~~' jP~~L 'n%`t'j~t'.2~:1~ <br />Sam le S lit: ~ Comments: /~ ~~ f <br />Flow/Level: pH: Temp. EC. Other: <br />Site ID.: Location: <br />2 <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />3 <br />Flow/Level: <br />S~G(oosY2 <br />Page _ of <br />~CJf. cr'-~j.rt'i. File ~: C-~~" ~`/`~ <br />c .C~~ .~~'~~ ~~x< / ~. ~= . Mine Contact: 4tn7 ;2:../,, <br />~,r,~_ <br />Temp. EC. <br />Other: <br />Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/CompositelFiltered/Raw <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />4. Site ID.: <br />Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: Time: <br />Sample Sptit: <br />Flow/Level: <br />5. Site ID. <br />Full Ground Water/Full Surface Water/Par[ial 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: To: Time/Date: <br />1. Transferred from: ////////// To: Time/Date: <br />Received at Lab by:~.'.- ~~~ Date: 5~~1/~J(i <br />Comments: <br />Temp. EC. Other: <br />Location: <br /> <br />8934F ~alr~ple~ Received In 0 0 O Y R M O D Y =. <br />