_GENERAL DOCUMENTS - C1981017 ‎(205)‎

• Permit No: C1981017
• IBM Index Class Name: GENERAL DOCUMENTS
• 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 #:
Company/Address: Mine Contact :
Specialist •
Date: Time: Weather:
Comments: Laboratory:
1. 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:
2. 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:
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:
5. 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:
CHAIN OF CUSTODY
1. Transferred from: + To: Time/Date:
1. Transferred from: To: Time/Date:
Received at Lab by: Date:
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