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. -•'- "~ III IIIIIIIIIIIII III ~ ~~ ~ ~~ Q,~I'Q.~v Page 1 of <br />v <br />MINED LAND RECLAMATION DIVISION <br />MONITORING FACT SHEET <br />((''~~ LABORATORY SAMPLES <br />oeration: L"') ~ ~ File fk: ~^~1 -~~~ <br />ompany/Address: Mine Contact: <br />pecialist:~ r <br />ate: (~/11~~ -Time: T Weather: e~Y <br />omments: ~...D~< ~~ r~c „n.,~e~.~1.9.~nOS~1 (~~1Laboratory: q L'Z. <br />Site ID.: r"1'~1-$ySS- ~ -h Location: C LC - E~,.~ y"e~us~ ~',1~ Ni~.~ <<"..~ <br />Full Ground Water/Full Surface Water/Partial Sample Geo /Soil/Grab/Composite/Filtered/Raw <br />Disposition: <br />Time: <br />Sample Split: (J /J} Commenta: <br />Flow/Level: pH: Temp. EC. Other: <br />Site ID.: 54..,P Location: ~,,,,~~., -~n~.S„~,\ S-~~,~ ~,~.~ <br />Full Ground Water/Full Surface Water/Partial Sample/Geo. Qj. /Grab/Composite/Filtered/Raw <br />Disposition <br />Time: <br />Sample Sp lit:~_Conmrents:~l4n~ t <br />Flow/Level: pH: Temp. EC. <br />-. Site ID.: Location: <br />Other: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition:~ <br />Sample Split: <br />Flow/Level: <br />Comments <br />Temo. EC. <br />Other: <br />Site ID.: Location: <br />Fnll Ground Water/Full Surface I,'ater/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition•- <br />Samole Split: <br />Flov/Level: <br />Site ID.: <br />Time: <br />Temp. EC. Dther: <br />Location: <br />Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw <br />Disposition: <br />Sample Split <br />Time: <br />Comments: <br />Comments: ' <br />Flow/Level: pH: Temp. EC. <br />Time: <br />Other: <br />MAIN OF CDSTODY <br />.. Transferred from: /`1 G~,~ _To: f~-C'>_ _ Time/Date:../~ l~ S' ~ ~.'~ ~ ~ ,.., <br />_. Transferred from: To: Time/Date: - <br />.eceived at Lab by: Date: <br />-~ ~/~ / ~~ <br />~-- <br />3°34F OOOYR*.ODYA <br />