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<br />-!t=~ ~- =` ~ JUN 6~~ ,.
<br />~°' ai; r Lab No. ~S-?'?y~/'9'E~'
<br />COLOR 0 DEPARTMENT OF HEALT{~'I~,cD L.~,PI:, i.,(;,.,•;,,,,:IC~y OAF pk
<br />W ter~ual ity Control DivisionF,ola~ 7e;,i. Gi ~Jatdr3: n'v;q~~"m Water Qua a a ee
<br />(~~anrple Collected by MLRD)....;..._......_ ............................. ..........
<br />ENFORCEMENT MONITORING FACT SHEET"
<br />1. Name of Company:
<br />2a. Name of Mine:rt
<br />3. Date of Contact:
<br />5. Mine contact/tit
<br />From: Ur-a,,. ~.•l,: lo: .{~~,. :-~~icr lime/uaze:`'~'='
<br />6. hone: Inspector Samp er:c.~', ~s ~.,;~., ~ ~._~- J<„~~
<br />8. Date an ime o amp ing: -i / - ?, „
<br />9. Does Mine Representative wish to a present?: .,~ ~
<br />10. If so, list; name, title, and phone: :,;.~ '--r-,,.tea.
<br />oes t e Aerator wis a Samp a sp iti ~,,,, Initia s:
<br />12. Will the Operator provide container? ~,,, Initials:
<br />13. Are there any special arrangements to meet at site. „ o
<br />14. Parameters to be Monitored: Total Suspended Solids ~ pH
<br />Temperature• Settleable Solids Iron anganese
<br />Other (list):
<br />15. Type of Sample: Gra 1~ omposite Descri a ocation Samp a was
<br />taken: -~ ,~;.,;, ~1r~1 ~ ,:~
<br />'"~~ ,
<br />16. Containers: f~ Plastic containers w/o acid Size: i L
<br />Plastic containers acidified w/HN03 Size:
<br />Other:
<br />17. Name & Title of Persons Present During Sampling: - ~.- u-..K~-~ ~-Ca..~' ;'~f~•::-
<br />18. Was sample split? „ ~
<br />19. Who Received or Deme Sp it Name, it e, mtia s ,;:-,-~= ~,,.,~,~ ~~
<br />20. Disposition o sample after co ection: --., .-. ~,_. _.:..~
<br />Transferred
<br />Transferred
<br />Transferred
<br />Received at
<br />Comments:
<br />From• o:
<br />From• To:
<br />From• o:
<br />Lab by:
<br />2. NPDES Permit#:
<br />2b. MLRD Permit#: C-o;3i -.~/
<br />4. Time of Contact:
<br />Time/Date:
<br />Time/Date:
<br />Time/Date:
<br />Time/Date:
<br />Note: La oratory ana ysis o the a ove mentione Samp a 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 />~ ,.
<br />Signature of Sampler: ~ ~ ~'~ ~- ~ ~„ / '_.'~~~~ , , _~
<br />. % `~~
<br />Doc, # 8683E-B
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