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. _~ <br />'. -- - ! `~ i~=- - - Page _ of <br />~.-.a <br />MIRED LAND RECLAMATION DIVISION <br />- MONITORING FACT SHEET <br />LABORATORY SAMPLES y}~~ <br />~oeration: i n C ' r~ .?Fi a #: C-~('- V ~~ <br />ompany/Address: p ~ ~ S - .y~ Hine Con[aet: i;,,, Ck <br />Specialist: p <br />ate: ~v 0 Time: /3~d weather: ,v <br />~omments: Laboratory: n / <br />Site ID.: Q/~q@(j~~~F /4 Location: 5e i2.C~ /C ~~l <br />~• <br />Disposition: - Time: <br />' Sample Split: `(ec Comments:L.yr~ ~.~ '.S <br />Flov/Level: pA: <br />~~ <br />Full Ground Water/Full Surface water/Partial Sample Geo /Soil/Grab/Composite/Filtered/Rav <br />Temp. EC. Other <br />Site ID.: Location: -- <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Rav <br />' Disposition: <br />Time: <br />Sample Split: <br />Comments: <br />Flov/Level: pH: Temp. EC: Other: <br />~. Site ID.: Location: <br />' Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Rav <br />Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />4. Site ID.: Location: <br />' Full Ground Water/Full Surface Water/Partial SamplelGeo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: ~ Time: <br />' Sample Split: Comments: <br />Flov/Level: pA: Temp. EC. Other: <br />~. Site ID.: Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Rav <br />' Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pR: Temp. EC. Other: <br />~AIN OF CUSTODY <br />Transferred from: To: Time/Date: <br />~. Transferred from: ~J To: Time/Da/te: <br />Received at Lab by: ,~/,.» ,~.~ Date: S~Qf4 <br />' T <br />d'ts~S4m CS <br /> <br />~934F OOOYRHOD`: <br />