GENERAL55082

• Permit No: C1981071
• IBM Index Class Name: General Documents
• Doc Date: 6/24/1987
• Doc Name: MONITORING FACT SHEET LABORATORY SAMPLES
• Permit Index Doc Type: SOILS
• Media Type: D
• Archive: No

•
~ PaRe _ o` ~~
`".INFO LA1~ P.ECLP'1A"ION DII~?SIGN III ~IIIII~I~IIIIIII
"tONITORING FACT SHEET I
LABORATORI' SA"!PLES
One ration: ~/im~..~ ~Cf~~(\ File ~F: / --? ~V~~/
CompanyJAddress: (~/~~~/1 p~,.,~C~ (~, / (~1,..7~~, Mine Contac[: /./ /,'/•'
Specialist: •/,..,~, ~~Jd~.=-;~?J
Date: , ,1 L-r Time: / -i„ Weather: /~.%f,r ~.
Comments: ~.,t/ ,,~-~,r , X ~v„~.,/yJ Laborator}•: ~.,,/ ~:/.. ~~t
1. Site ID.:G7(~~,~r~T7f~~ Location:-(, "w~r~./-f~'tl ,~i ,~4~~c
Full Ground Water/Full Surface Water/Partial Sample/Geo.( oil/ rab/ omoosiie/Filtered/Raw
~/ /' P ~~
Disposition: ~,/.~ (,'i"1~ ,,// Time: C/ („~.~(;/y7
Sample Split: //, r, Comments:~c,~yn~.2" ~iC,~-, ~ ~rCi-~r~~rJ ,o//: ~ -~~"~7
Flow/Level: pH: Temp. EC. Other: /
_. Site ID.: Location:
Fu11 Ground W'a[er/Full Surface Water/Partial SamplelGeo./Soil/GrabJCompositeJFil[ered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. Other:
i. Site ID.: Location:
Full Ground WaterlFull Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow(Level: oH: Temp. EC. Other:
. Site ID.: location:
Full Ground (dater/Full Surface Water/Partial Sample/Geo./Soil/G-ab/Composite/FiLte red/Raw
Disposition: Time:
Sample Sp1i[: Comments:
F1owJLeve1: pH: Iemp. EC. Other:
i. Site ID.: Location:
Fu 11 Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/P,aw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. Uther:
=:IAIN OF CUSTODY
_. Transferred from:
_. Transferred from:
ieceived at Lab by
To: Time/Date:
To: Time/Date:
Date:
i934F 0 0 O Y R "1 O D Y A