HYDRO22571

• Permit No: C1981048
• IBM Index Class Name: Hydrology
• Doc Date: 7/20/1992
• Doc Name: SAMPLE DATA
• Permit Index Doc Type: DMG SAMPLING
• Media Type: D
• Archive: No

:,, .
f"
COLORADO DEPARTMENT OF HEALTH Water Lab No.
Water Quality Control Division (From Water Qua.. a a heet
(Sample Collected by MLRD)
ENFORCEMENT MONITORING FACT SHEET
1. Name of Company: 2. NPDES Permit#:
2a. Name of Mine: 2b. MLRD Permit#:
3. Date of Contact: 4. Time of Contact:
5. Mine contact/title a ress:
6. Phone: 7. Inspector{Sampler:
8. Date an lime of Sampling:
9. Does Mine Representative wish to be present?:
10. If so, list name, title, and phone:
11. Does the Operator wish a sample sp it? Initia s:
12. Will the Operator provide container? Initials:
',3. Are there any special arrangements to meet at si;.e?
14. Parameters to be Monitored: Total Suspended So1~~1s pH
Temperature Settleable Solids Iron -~Ffanganese
Other (list):
15. Type of Sample: Grab ~_ Composite Describe ocation samp a was
taken:
16. Containers: Plastic containers w!o acid Size:
~_ Plastic containers acidified w/HN03 Size: ___
Other: _ _ _ __
~!. Name & Title ~i` Persons Present During Samp in;.
18. Was sample split?
19. Who Received or Denied Sp it Name,Tit e, Initia
20. Disposition of sample after co lection:
Transferred From: To: Time/Date:
Transferred From: _
To: ___
Time/Date:
Transferred From: To: Time/Date:
iransferred From: To: Time/Date:
Received at Lab by: _
Time/Date:
Comments:
Note: If Laboratory ana ysis n the above ment~one samp a in icates a
violation of the "Water Quality Control Act", or other State or Federal water
quality Laws, these results may be used in the future for enforcement actions.
Signature of Sampler:
Doc. # 8683E-B