HYDRO26643

• Permit No: C1981071
• IBM Index Class Name: Hydrology
• Doc Date: 6/5/1987
• Doc Name: DISCHARGE SAMPLE
• Permit Index Doc Type: DMG SAMPLING
• Media Type: D
• Archive: No

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COLORADO DEPARTMENT OF HEALTH
Water Quality Control Division
(Sample Collected by MLRD)
1. Name or ;:uinpauy:
2a. Name of Mine: Ec/,
3. Date of Contact:
5. Mine contact/title ac
s
in
ass: ~r%~ ~; ~ ~.
~ y _. ,_ r ,~a-, rr~~.,.
d. rnone: - ~~ - ~.3oJ 7. Inspect
8. Date an Time of Sampling: ~y „/- ~
9. Does Mine Representative wish to be presen
10. If so, list name, title, and phone: j~,
Water Lab No.
(From Water Qua Data Sheet
2. LrULJ rer~atCc: 11/J t
2b. MLRD Permit#: G,i/-~ 7/
4. Time of Contact: , i~/.~
~.~
er:
II. Does the Uperator wish a sample split? y% ~ lnitials:~
12. Will the Operator provide container? ,,/p Initials: i
13. Are there any special arrangements to meet at site?
14. Parameters to be Monitored: Tota] Suspend
~ d Solids :/ pH
Temperature Settleable Solids Iron Manganese
Other (list):
15. Composite
Type of Sample: Grab Describe ocation sample was
_
taken: ~..~,~~./~~~~-, ~/Y~::e ~.,/,c.~ ~p.i.~;cri`/~.s./ -~
v P18stic containers w/o acid
16. Containers: Size: ~,/ ~
_
Plastic containers acidified w/HN03 Size:
_
Other:
17. Name & Title of Persons Present During Sampling: jen•c!% w ,,r._-.,;
18. Was sample split? ~r~ s
1g. Who Received or Denied Split Name,Title, Initials ,-~
ler~~el~ ~i~+;= Ur I y1
20. Disposition of sample after co lection: `'

Transferred From: /,;,~~•i~
~_To: ~,;,,,,~f Zc%~~,..-.Y_ lime/Date:3, o~ f,~, ~
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Transferred From: To: ~ Time/Date:
Transferred From: To: Time/Date:
Transferred From: To: Time/Date:
Received at Lab by: Time/Date:
Comments•

Note: If Laboratory analysis o the above mentione samp a in icates a
violation of the "Water Quality Control Act", or other State or Federal µCter
quality Laws, these results~~y be used in the future for enforcement actions.
Signature of Sampler: ~"/ ~~~~
Doc. # 8683E-B '
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