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'--~'~'- ~ ... _. - - Page _ of <br />- ~, <br />T J _ riINED LAND RECLAMATION DIVISION . <br />'~ =~==_ - '-_ -' ° ~- MONITORING FACT SHEET <br />- -~ LABORATORY SAMPLES p <br />'Operation: j~C' - - == File is C-~ '~~p <br />Company /Addres Q S ~ h - Mine Contact :.., <br />' Specialist: S <br />Dater Time: J3;~ Weather: td~/S <br />Comments: - Laboratory: <br />'1. Site • ID.: ~(,QQ~ ~~,~ /~ Location: $ p / ~ ~ !lP <br />Full Ground Water/Full Surface Water/Partial Sample/Geo. Soi Grab/Composite/Filtered/Rav <br />' _Disposition: // Time: <br />Sample Split: ~pS Comments:~~~f.TC-'T~ys~. .S d7~~Sa~~J,S <br />Flov/Level: pH: Temp. EC. Ocher: T Qie~ Y <br />' 2. 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 />Flov/Level: pH:_ <br />Temp. EC. Other: <br />3. Site ID.: Location: <br />' Full Ground Water/Full Surfaee Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Rav <br />Disposition: Time: <br />' Sample Split: Comments: <br />Flov/Level: pH: Temp. EC. Other: <br />'4. Site ID.: Location: <br />Full Ground Water/Full Surfaee Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Rav <br />' Disposition: Time: <br />Sample Split: Comments: <br />Flow/Level: pA: Temp. EC. Other: <br />15. 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 />' Flov/Level: pH: Temp. EC. Other: <br />CRAIN OF COSTODY <br />1. Transferred from: To: Time/Date: <br />1. Transferred from: To: Time/Dace: <br />'Received at Lab by: 0~ / uU~cz: Date: ~9~Fi.~ <br />'8934F OOOYRuOD <br />