REP29222

• Permit No: C1981039
• IBM Index Class Name: Report
• Doc Date: 5/31/1987
• Doc Name: DMG Water Sample 039870519A Water Quality Results
• Permit Index Doc Type: HYDROLOGY REPORT
• Media Type: D
• Archive: No

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MINED LAND RECLAMATION DIVISION
MONITORING FACT SHEET
LABORATORY SAMPLES
Operation: LAY ~< File dk: (~ - h
Company/Address;., ~~ c Vic; ~ //r ~
Specialis L-M~ .. ~T P
Date: .i /`7 Time: /i/1{. Weather: /~ ,;~,. t
Comments: __ ' Laboratory:
O3gs7os /qi~
1. Site ID.: ~7~"v~-c~~e.( Location: ~~ / ~ T ¢J1J~
Full Ground Water/Full Surface Wat/e Partial Sam Gyeo./S it/Grab/Composite
Disposition: / ~C/N! - ~ ~/Ptctn Time:
Sample Split:
Flow/Level: ~~~5 c/
2. Site ID.;
Comments:
Full Ground ldater/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition:
Sample Split:
Flow/Level:
Temp. EC.
_pH:,7 ~7Temp.,7 ;DEC. ~.~Q /~ Other:
Location:
me:
Comments:
3. Site ID.; Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
4
Sample Split: Comments:
Flow/Level: pH: Temp.
Site ID.: Location:
EC.
Other:
Other:
Full Ground Yiater/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH
5. Site ID.:
r ~Sf i lr ~~ /1
Page ~ of I
1039
Mine Contact:
-Temp. EC.
Location:
Other:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH:
CHAIN OF CUSTODY
Temp. EC. Other:
1. Transferred from: To: Time/Date:
1. Transferred from: To: Time/Date:
Received at Lab by: ~. ~~
~ / Date: _ ~
8934F OOOYRMODYA