PERMFILE51443

• Permit No: C1981031
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Section_Exhibit Name: Section 3: Rule 2.04
• Media Type: D
• Archive: No

___ _ __ _ _
WATER SAMPLE INFORtutAT ION ~ /~, (G ~\
I ~.v
- Table 2.04.7(1)-4.(eant.) T` ~ , ~,~
` i 7~ ~ ~
Name /(~ E Z_ L -a.v i ~ ~ f! %
~p ~/d~v ~~' J~
Address_~o /'~ n X ~( ~ 5 v l t- v9.e ~e
'~~n 9d/-9 S'Y9
Date sample col lected_R,,~,,,.e 3 - f ~ Analysis: Paid l~Charge
Anticipated use of water: Household including drinking)
Laundry only Livestock ~_ Irrigation~_
Scurce of supply Well~_ Streem 5prinp Lake
~r ~ F r
If welly depth /o ~ normal water level ~~ '
Location of supply: (Example 22 miles SE of Ft. Collins)
y f ~~ ~/ o ~(~ 5 ~o iPf ~ HaP ID 5~
=+d~iition~l information:
J
JFSA-26
~ 12 G~
,.
J. E SATO & ASSOCIATES, INC.