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(~~'.w.aw QarK 7tl'1ll <br /> <br />• <br />Operation: I~+e'~ <br />Company/Address: Cd <br />Specialist: S'lev. ~~„„ <br />Date: ~ 's Mime: <br />General Location:_ <br />General Comments: <br />MINED LAND RECLAMATION DIVISION <br />W N N HEET <br />~c <br />I. FIELD SAMPLING <br />Site~.~ype_ Flow/Level pH <br />• III III III III IIII III <br />999 <br />k+a.+ /'Ark File #: 7Y-177 <br />a, D:~Kk~~ AaN y /blip, , p <br />feather: Cla~ -r <br />EC Temp Comment <br />'t .~ D`~ F U'F ~' ~ H <br />t ~ is ~ ~E !: w ~ fM <br /> <br /> <br /> <br /> <br /> <br />II. Laborator Sam les ~ lC <br />Lab: < Z Parameters: u Sir c Descri4Ltion: <br />Disposition:,~ra oci~l ;~ ra Compos <br />Sample Split: e,f omments:,aM, ~ ci~cva n~ n"r,~.~ <br />Flow/Level: pH: .~~ Temp.ij3~~~ EC. ~O Other:_ <br />2. Site ID.: E K5f50 <br />Lab: Parameters: ~,, 1 v c Descr ion: Fc: <br />Disposition:~~„C~~;.~~~ic~ ra /Compos <br />Sample Split:'(~S Comments:~le 0•S~t <br />flow/Level: ~ Temp.-15,T •3 60 t er:_ <br />O <br />tY.+5,1 <br />Site ID.: Location: <br />Lab: Parameters: escription: <br />Disposition: Grab/Composite: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />Site ID.: Location: <br />Lab: Parameters: Description: <br />Disposition: Grab/Composite: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />Site ID.: Location: <br />Lab: Parameters: Description: <br />Disposition: Grab/Composite: <br />Sample Split: Comments: <br />Flow/Level: pH: Temp. EC. Other: <br />CHAIN OF CUSTODY <br />1. Transferred from: <br />1. Transferred from: <br />1. Transferred from: <br />1. Transferred from: <br />Received at Lab by: <br />G <br />To: t%1. Time/Date:~~ 0~ <br />To: Time/Date: <br />lo: <br />To: <br />Date: <br />ime/Date: <br />ime/Date: <br />4/85 Doc. #8934F <br />