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® CLIMAX MINEcWWAOTER QUALITY PROGRAM <br /> CHAIN OF CUSTODY / SAMPLE FIELD DATA <br />• - <br /> FIELD DATA <br /> SAMPLE IDENTIFICATION/ LOCATION: G,eO&NO LILLE ROAHrOfW6 `UEGL IY6. <br /> SAMPLE TYPE: ? Regular ?Special GROUND WATER ONLY: <br /> SAMPLE DATE STATIC WATER LEVEL Ft. <br /> SAMPLE TIME PURGE TIME Min <br /> <br />pH TEMPERATURE 'F . <br /> APPEARANCE: ? Clear ? Slighfly Turbid ? Turbid ? Very Turbid <br /> WEATHER: ? Clear ? Cloudy ? Rain ? Snow ? Nof Applicable <br /> BYPASS IN PROGRESS: ?Yes ? No ? Not Applicable <br /> TREATMENT SYSTEM OPERATIONAL: ? Yes ? No ? Not Applicable <br /> VISIBLE OIL: ? Yes ? No ? Not Applicable <br /> ANALYSIS REQUIREMENTS <br /> -------------- -- T P D R <br /> 0 pH ? OIL/GREASE <br />? SOLIDS - Suspended a coo ; ? ? ? ? ALUMINUM <br />? ? ® ? CADMIUM <br /> ® SOLIDS - Dissoived ? TURBIDITY [NTUI <br />? AMMONIA as N ? NITRATE ' ? ? ® ? COPPER <br />? ? ® ? IRON <br /> ? UN-IONIZED AMMONIA - Calc i ? ? IM ? LEAD <br /> ? PHOSPHORUS <br />? FLUORIDE ? ? IN ? MANGANESE <br />• <br />0 HARDNESS ? ? ® ? MOLYBDEtdUM <br />? ? ® 11 ZINC <br /> t - rarac <br />? SULFATE as SOa <br />? ? ? ? SILVER <br /> 0 <br />SPECIFIC CONDUCTANCE ANALYSIS REOUIRM P - POrENTIALLY DISSOLYED ? ? C] ? <br /> 11 <br />CYANIDE M - YES ? - NO D - OISSOLVEO <br />? ALKALINITY _ <br />? ? ? ? <br /> R - WALRECOV£RABLE ? ? ? ? <br /> ? ? ? ? <br /> CHAIN OF CUSTODY <br /> SAMPLED BY: <br /> NAME IP/Int] SIGNATURE DArE TIME <br /> RELINQUISHED BY: <br /> NAME [Print] SIGNATURE OATE r1ME <br /> RECEIVED BY: <br /> NAME lPrinl] SIGNATURE DArE rw <br /> RELINQUISHED BY: <br /> NAME !Print] SIGNATURE OArE riME <br /> RECEIVED BY: <br /> NAME rPrinll SIGNATURE OATE r1M£ <br /> RELINQUISHED BY: <br /> NAME lPrlnl] SIGNATURE DATE TIME <br /> REC. FOR LAB BY: <br /> NAME [Print] SIGNATURE <br />IMMMEMMMmm <br />m DArE rlmE <br /> m <br />RETURN ANALYSIS RESULTS AND m <br />• CHAIN OF CUSTODY FORMS TO <br /> worm No.: CLXNOA-11191 <br /> GkrM /-L <br />