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COLORADO DEPARTMENT OF HEALTH <br />Water Quality Control Division <br />(Sample Collected by MLRD) <br />Water Lab No. '~ '~'= 1 <br />(from Water Qua ata neet <br />EMENT MONITORING FACT SHEET <br />1. Name of Company: F.~,~-~ F,,,~iS r,,~~, 2. NPDES Permit#:C CD -(1p~`1S6~i <br />2a. Name of Mine: R~,.~ rgg~, 2b. MLRD Permit~:[_-p,a-UPS <br />3. Date of Contact: _ ~~ g 4. Time of Contact: <br />5. Mine contact/title a dress. <br />6. Phone: Inspector/Samp er:ia„ tom,/ ~ G .z K <br />8. Date an ime o Samp ing: i <br />9. Does Mine Representative wish to be'present?: <br />10. If so, list name, title, and phone: <br />1 Does the Operator wish a Samp e sp it? ~7~ ~ lnitia s: ~ <br />12. Will the Operator provide container? ~ , Initials: <br />13. Are there any special arrangements to mee at site? <br />14. Parameters to be Monitored: Total Suspended Solids pH <br />Temperature Settleable Solids Iron _~ anganese <br />Other (list): <br />15. Type of Sample: Grab Composite ~ Describe ocation sample was <br />taken: A!'Flet ~FIu N,E Of'.se~'~:+,onf ~'~-.n rl he.lou~ re.~u c.p_ P,"/c,_ <br />16. Containers: v Plastic containers w/o acid Size: <br />/ Plastic containers acidified w/HN03 Size: <br />Other: <br />17. Na e 8 Tit a of Persons Pr sent During Sampling: \ <br />18. was sample splits e. <br />19. Who Received or Denied Sp it Name,Tit e, In <br />sposition of sample after collection: <br />ransferred From: Y• ~_ To: lime/Date: ;'. ~ a~/g~1 <br />Transferred From: 70: Time/Date: <br />Transferred From: To: Time/Date: <br />Transferred From: To: Time/Date: <br />Received at Lab by: /_ O _ ,"-„ ~ -d 3 -.F S Time/Date: <br />Comments: / ? 'a ~ <br />Note: if Laboratory ana ysis or the above mentioned sample in icates a <br />violation of the "Water Quality Control Act", or other State or Federal water <br />quality Laws, these results may be used in the future for enforcement actions. <br />Signature of Sampler: ~• ~ ~~ ;,_ 17~ ( /~.vvi? <br />Doc. ;u 8683E-B <br />