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--~--- <br />~II ~I~~I~~I~~~~~ DI~ ~a ~ <br />99y Page _ of _ <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />FIELD SAMPLING <br />Operation: File ~kk: ' <br />Company/Address: Mine Contact: ~~ <br />Specialist: _ <br />Date: Time: Weather: <br />Comments: Laboratory: <br />Site ID. T e Flow/Level H EC Tem Y,Bailed Comments '~ <br />CHAIN OF CUSTODY <br />1. Transferred from: To: Time/Date: <br />1. Transferred from: To: Time/Date: <br />Received at Lab by: Date: <br />B934F 000YYMM'DDA <br />