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COLORADO DEPARTMENT OF HEALTH
<br />Water Quality Control Division
<br />(Sample Collected by MLRD)
<br />TORING F
<br />1. Name of Company:S~'6wi
<br />2a. Name of Mine: , ~ g
<br />3. Date of Contact: of zc: ~
<br />5. Mine contact/title a ress:
<br />Ro . 8 ~ (n8 C~Q.ta G 81
<br />6. Phone: ~ ZtS
<br />8. Date an ,me o amp ,ng: ul t~
<br />9. Does Mine Representative wish to be
<br />10. If so, list name, title, and phone
<br />ame,I,tie, im t,a
<br />ii. uoes the uperator w,sn a sample spl,tt in,t,ais:
<br />12. Will the Operator provide container? Initials:
<br />13. Are there any special arrangements to meet at s,te. ,,,,~
<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 _~Iro[pos~ite _ Descr, a ocat,on samp a was
<br />taken: p~ NPDEC e•u ( on ~
<br />16. Containers: Plastic containers w/o acid Size: 1 ~¢~,
<br />Plastic containers acidified w/HN03 Size:
<br />Other:
<br />17. Name & T,t a of Persons resent During Samp ,n ~ ~ Sr.Env.Er~,
<br />Sfu ~,nnn VYl.t~rri ~ R~,Q Mi ,n ~ rr6, G,~ o,~.i n Ui 1
<br />19. Wh~Received 1jT' Den
<br />spos,t,on
<br />Transferred
<br />Transferred
<br />Transferred
<br />Transferred
<br />Received at
<br />Comments:
<br />Time/Date:
<br />Time/Date:
<br />Time/Date:
<br />Time/Date:
<br />4
<br />1
<br />r~- ~ ; c,, ifi3
<br />Note: La oratory ana ys,s o tea ove ment,one samp a ,n ,cates 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: ~2~K. (~'Y~ts~i,,~.Krt.`
<br />e after collect,on:
<br />Water Lab No. pQ3`~301 Z(p
<br />(From Water Qua ata heet
<br />2. NPDES Permit#:Ce-
<br />2b. MLRD Permit#:~
<br />4. Time of Contact:
<br />er:
<br />9~ i5'.ZS
<br />present?:
<br />?err r(~ &r. EnV E,~a4.
<br />from : ~ /77,d'yti,i,~ .t-t, i o
<br />Fram: To:
<br />From: To:
<br />From• To:
<br />Lab by:
<br />Doc. # 8683E-B
<br />
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