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<br />COLORADO DEPARTMENT OF HEALTH Water Lab No. S y <br />Water Quality Control Division (From Water Qua ata heet <br />(Sample Collected by MLRD) <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 a ress: <br />6. Phone: ~ 7. Inspector/Samp er: <br />8. Date an ime o amp ing: <br />9. Does Mine Representative wish to be present?: <br />10. If so, list name, title, and phone: <br />. Does t e Operator wish a sample sp it? Initials: ; <br />12. Will the Operator provide container? Initials: <br />13. Are there any special arrangements to meet at site? <br />14. Parameters to be Monitored: Total Suspended Solids pH <br />Temperature Settleable Solids Iron -Manganese <br />Other (list); <br />15. Type of Sample: Gra Composite _ Describe ocation Samp a was <br />taken: <br />16. Containers: _ Plastic containers w/o acid Size: ~ <br />_ Plastic containers acidified w/HN03 Size: <br />Other: <br />17. Name & Tit a of Persons Present During Samp ing: <br />18. Was sample split? <br />19. Who Received or De m ed Sp it Name,Tit e, Initia s _ <br />20. Disposition of sample after collection: <br />Transferred From: ~ - To: Time Date: <br />Transferred From: To: Time/Date: <br />Transferred From: To: Time/Date: <br />Transferred From: To: Time/Date: <br />Received at Lab by: Time/Date: <br />Comments: <br />ote: It Laboratory analysis of the above mentioned sample indicates 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: <br />Doc. # 8683F-B <br />