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COLORADO DEPARTMENT OF HEALTH <br />Water Quality Control Division <br />(Sample Collected by MLRD) <br />Water Lab No. <br />(From Water QuT ata heet <br />ENFORCEMENT MONITORING FACT SHEET <br />1. Name of Company: ~ 2. NPDES Permit#: ! <br />2a. Name of Mine: 2b. MLRD Permit#: <br />3. Date of Contact: 4. Time of Contact: <br />5. Mine contact/title ress: o „~ .~ ,_ <br />- b. Phone: \ /. <br />b. Date an ime o Samp ing: <br />9. Does Mine Representative wish to be <br />10. If so, list name, title, and phone <br />nspector~~ampier: <br />4\ Jf`~\ <br />prescentr: ,1 <br />Jcl Ynr ~l 'A-2t) <br />li. uoes the uperator wisn a sample spiiu ~ initials: 7 <br />12. Will the Operator provide container? Initials: <br />13. Are there any special arrangements to eet at site? \/cps <br />14. Parameters to be Monitored: Total Suspended Solids pH <br />Temperature Settleable Solids Iron -Ffa ganese <br />Other (list): _(~1\ r} ~~re.s.. ~; u ~ r'~~r~.T~~[~~~J~ <br />15. Type of Samn'~\le• rab Compos a epscribe o an on campnp ems <br />taken: P~nLt •!\(\~ CinrSnS i~~~n~ont4 N PnS C14i~~C~ pf\QP _ <br />. Containers: Plastic containers w/o acid Size: <br />Plastic containers acidified w/HN03 Size: <br />Other: ~ (~~~ C`u ~~ a 1, e r - \ ~'~•~ r <br />17. <br />of Person <br />18: Was sampl8 split(! <br />19. Who Received or De <br />t Uur`ing Sa~plinga 5 <br />ame,Tit e, Initia s ~ ~ M Q <br />Transferred rrom: /,;~~:., ;~/,,,__.~. , lo: <br />Transferred From: ',_r- .~d .. ! i'~.t , ; /~ To: <br />Transferred From: To: <br />Transferred From: To: <br />Received at Lab by: <br />Comments: <br />'.,.LV',;~~ t <br />,Kline <br />i E~~ee~ <br />~.~- <br />Time Date: C j/?/.' - ? <br />Time/Date: G~ /, ~ /s ~; ~,:~`4 „~ <br />Time/Date: <br />Time/Date: <br />Time/Date: <br />Note: I Laboratory ana ysis o the above mentioned Samp a in icate:> a <br />violation of the "Water Quality Control Act", or other State or Fecieral water <br />quality Laws, these results may be used in the future for enforcement actions. <br />Signature of Sampler: <br /> <br /> <br />Doc. # 8683E-B <br />