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.. . <br />COLORADO DEPARTMENT OF HEALTH <br />Water Quality Control Division <br />(Sample Collected by MLRD) <br />1. Name of Company: <br />2a. Name of Mine: <br />3. Date of Contact: <br />5. Mine contact/tit <br />Water Lab No. ~~P 6 ~~ <br />{From Water Qua ata heet <br />ITORING FACT SHEET <br />2. NPDES Permit#: <br />,k~.., 2b. MLRD Permit#: <br />4. Time of Contac <br />V• III V IIC• O /• 1 <br />8. Date an ime o amp ing: 3(~cj <br />9. Does Mine Representative wish to be <br />10. If so, list name, title, and phone: <br />or/Sampler <br />II. Does the Operator wish a sample split"? NO initials: <br />12. Will the Operator provide container? y~y Initials: <br />13. Are there any special arrangements to meet at site? U <br />14. Parameters to be Monitored: Total Suspended Solids pH <br />Temperature Settleable Solids / Iron / anganese <br />Other (list): <br />15. Type of Sample: ra Composite _ Describe ocation samp a was <br />taken: <br />16. Containers: ~ Plastic containers w/o acitl Size: <br />~_ Plastic containers acidi ied w/HN03 Size: <br />Other: ~OIU ..~(~G~n~ <br />17. Name & Tit a of Persons Present During Sampling: ,('im(.T~ <br />18. was sample splits rv v <br />1g. Who Received or Denie p it Name,Tit e, Initia s <br />20. Disposition of sample after co lection: <br />iransrerretl rrom: ~rl~'I io: W R iimeiuate: <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: ~timr, lln ._lvnm ai(~ira-~ 0. ,SD/ uvi,vr ~ -.~ ~a47m <br />Signature of Sampler: <br />~~~91~ <br />Doc. # 8683E-B <br />nu w. al i.auulawl,~ ana1~'DIJ ul I,nc auurc woll.lvncu ~aulN lc Iglu lvaLCO a <br />violation of the "Water Quality Control Act", or other State or Federal water <br />quality Laws, these result;may be used in the future for enforcement actions. <br />