GENERAL36720

• Permit No: C1981041
• IBM Index Class Name: General Documents
• Doc Date: 5/9/1990
• Doc Name: MONITORING FACT SHEET LABORATORY SAMPLES
• Permit Index Doc Type: SOILS
• Media Type: D
• Archive: No

. .`
Operation• F6(>f
Company/Address:
Specialist:
Date: p
Comments-
_ ~.
III IIIIIIIIIIIIIIII _ Page _ of _
ri:
__.,D LAND RECLAMATION DIVISION
' -- - MONITORING FACT SHEET -
/ //~~ LABORATORY SAHPLES (~
~GQJ CLlvrJ~ ~ File fi:_ CB('0 (~ ~
~iy~2r~ M ,p PodoX /yjc7 ~~ Hine Contact: `~"'"I PYx'Jc
/x;00 Weather:
1.. Site ID.: Q4{ C)~ p~~S B Location: ~'~'+~
Full Ground Water/Full Surface Water/Partial Sample
Disposition: N
Sample Split :_ c6S Comments :_ ~~pmQdC~/~
Flov/Level:
2. Site ID.:
Temp. EC.
Location:
-Lab/oratory:-
~O~ ~ ` c~7~f~ f {
g~ ~ ~
Soil rab/Composite/Filtered/Raw
Time~~~
S JY( ~co.r~ o~ -Si~
Other: ~~rw~
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition•
Sample Split: Comments:
Flow/Level: pH:
3. Site ID.:
Time:
-Temp. EC. Other:
Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split:
Flow/Level:
Temp. EC.
Other:
i. Site ID.: Location:
Full Ground 4)ater/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
Sample Split: Comments:
Flow/Level: pH: Temp. EC. Other:
Site ID.: Location:
Full Ground Water/Full Surface Water/Partial Sample/Geo./Soil/Grab/Composite/Filtered/Raw
Disposition: Time:
5
Sample Split:
Flow/Level:
Temp. EC.
Other:
CHAIN OF CUSTODY
1. Transferred from: ~~' To: Time/Dace: ,5 /7 ~ ~ U
1. Transferred from: To: Time~/Da~~e:
Teceived at Lab by: ~ ~sGti Date: /9/yam
~, -T~_
Comments:
Comments:
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