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OOd~TtADO DEPA}7t~I~ OF HEALTH <br />Water Quality Ount~l Division <br />I.AB. . <br />FROM IYA Q[JALITY DATA SfiEEr <br />rT"iA~Ri:Eri,:.T .L~Uiri1LJ1{L'yJ FaC!' SHlvi!' <br />..ti <br /> <br />1. Name of Eatity: ~~) ~~P.C~'T z. PP,>.mit e-1- gS 1 ~a <br />3. Date of Oontact: /-. a4 -q ~ - 4. Time of~(batact: O Y3 0 <br />5. Person oontaated (name & ti le): 114c~ lla~on, ~ri,ct <br />6. Phone No. where be can be reached: 7(4-L.7~ 4~.~ 7. Wntaet~d by: <br />8. Date of Scheduled Sampling: <br />9. Does Representative of Entity Wish to be Present? R,P~ <br />10. If so, what is his auame, tiii~ :...: , ~;,~:: ;: ~:~r:r?._.~~1J_ x-sa <br />il. Do they wish to split samples? Ye S j <br />12. If so, will they provide container? <br />13. What arraagenents have been made to meet re?resentative and/or in entrance to the <br />facilities: <br />14. Parameters to be m~nitomed: BCID Suspended Solids D. pH <br />Fecal Ooliform Tempex'ature Tlmbidity Chlorine idual <br />Oil & Grease Orffi'liS (list): ~~GYaIJ~~y~1J /-ro 5 ~_ <br />15. Type of sample (grab or composite, 'describe)? S R <br />1&. <br />or <br />17, Persons present during sampling (names & titles): <br />~ Ate S /Z.Of~ P427 SA-w ~ H YhJ 2 HA~/~SA~?,d2 ~ <br />18. Was sample spli <br />19. Who received or <br />20. <br />,~ <br />mote: If laborator anal sis f " <br />Quality Control Act." these res~~lts may be used. in the future_..for enforcement actions. <br />