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D~ADO DFPAIIi1dI'Slf ~' HEAiaSi LAB. <br />Water Quality Oontrol Division Fll~d <br />~t7R(:Ei%::~T .lYJiri1T)liL'iii 1~aC1' SHlv:;l' <br />1. Name of Eatity:_ <br />3. Date of Q~atact: <br />5. Person oonta,cted <br />6. Phone No. where he can be reached: 7~q-L,7~ 4J1 <br />8. Date of Scheduled Sampling: / -aQ -4"7 <br />9. Does Represeata.tive of F}rtitp Wish to be Present? <br />10. If so, what is his atame, titi~ .... _ :;*:. ,.: ~~=r'._ <br /> <br />i <br />I <br />Ji <br />;.I <br />Il. Ib they wish to split samples' Ye S <br />12. If so, will they provide container?~ <br />13. iPhat arranganents have been made to meet <br />facilities: <br />a <br />4 <br />14. Parameters to be monitored: B(lD Suspended Solids D <br />Fecal Cbliform Temperature Turbidity Qilorine <br />Oil & (bease t7D'i{'liS (list): ~,~G`lAlJt~e <br />15. Type of sample (grab or conposite, 'describe)? t~-/3 Si4M, <br />]B. <br />or <br />PK <br />17. Persons present during samalirg (names & titles): <br />~ A1~ 7 /2,d~3 Pv2,'>~i~ ~ M /-W2 1"f~h'.SI+C-yL'~tZ <br />18. Was <br />J9. Wh0 <br />`~ . <br />~~ <br />OI' <br />.~7 nne Ac~ir1.2., nor ll_I 4'G1BU i1- <br />Permit ~: ~''/' ~g 1~.~ <br />Time of +(bntact : p g3 p <br />entrance to <br />Note: If laborator anal sis f h ~ <br />Quality Control Act," these results may be used, in the future,.,,for enforcement actions. <br />