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<br />ODLC(tADO DIPARII~Nr OF IiE14I3Ii <br />Water Quality dontrol Division <br />I.AS..N[R~lt: <br />FRlJM S4A7~R QUALITY DATA Sf~ET <br />r'Ik"el~Ri;Ea",•:.T .lRJiyITLdilii(i I'AC1' SHLl:l' <br /> <br />1 <br />I <br />1. <br />3. <br />5. <br />Name of Eatity:_ <br />Date of Q~nta,ct: <br />Person contacted <br />6. Phone No. where he can be reached: 7~`1-L~~~ 4f~ <br />8. Date of Schedhrled Sampling: la..4 .-~,''7 <br />9. Does Representative of I~ntity Wish to be Present? <br />10. If so, what is his =lame, title ..... ;e:: ,. ra•;r?_ <br />Permit ~~/- gO ! ~~ <br />Time of ntact: D Y3 O <br />11. Do they wish to split samples? Y~ s - - <br />12. If so, wi11 they provide container? <br />13. What arrangements have been made to meet representative and/or in entrance to the <br />facilities: <br />14. Parameters to be monitored: Boo Suspended Solids D <br />Fecal Ooliform T~perattme T~mbidity Chlorine <br />Oil & Grease OIH{~liS (list): ~-@GYAN-~ <br />15. Type of sample (grab or ooaposite, <br />1&. <br />or <br />PR <br />17, Persons present during sampling (names & titles): <br />dAn 3 /Z.of~pe2'7'~n$' MyhT2 YfA •.~ <br />18, Was sample spli <br />19. Who received or <br />20. <br /> <br />~C <br />1 Act," <br />t h~ <br />