1992-09-25_GENERAL DOCUMENTS - C1981017

• Permit No: C1981017
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 9/25/1992
• Doc Name: Bid Documents ‎(IMP)‎
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

Page of
• MINED LAND RECLAMATION DIVISION
MONITORING FACT SHEET
LABORATORY SAMPLES
Operation: File #• �__
� - ti 1 —'
Company/Address: Mine Contact:
Specialist: 7 - % � , .
Date: I Time: u', Q ,,n Weather: \
Comments: Laboratory:
I. Site ID. : Location: C , ,'
Full Ground Water,(,`�ull Surface Waterl artial Sample/Geo./Soil/Grab/Composite Filtered,/Raw
Disposition: - `�. J \� ,- 1,
Time: t -.
Sample S lit .
P P •I , ', Comments:-
Flow/Level: pH:�„� emp:% * EC. _ Other:
2. Site ID. I ,,,� 1;oc tion77-6
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: T mp. EC. Other:
3. Site ID. : Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. Other:
4. Site ID. : -Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split : Comments:
Flow/Level: pH: Temp. EC. Other:
S. Site ID. : Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments: ;.
Flow/Level: pH: T mp. EC. Other:,—
CHAIN OF CUSTODY
1. Transferred from: To: Time/Date: _
1. Transferred from: To: Time/Date:
Received at Lab by: Date: -
8934F 0 0 0 Y R M O D Y