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• III IIIIIIIIIIIII III • <br />ODIiQ2AD0 D1~AA41d):Nr OF HEALTH LAB. . <br />Water Quality Gbntrol Division, 1:1~M 14A i QUALITY DATA S[~P <br />~URCEr,: s.T .L+Uiti:l'..°iiIi~Ci F:~Cl' Stil•:i:l' <br />1. <br />3. <br />5. <br />Name of Eatity:_ <br />Date of Oontact: <br />Person contacted <br />6. Phone No. where be can be reached: 7. intact by: ~1{-He S A![.Ue_ <br />8. Date of Scheduled Sampling: ! _ ~-9 7 <br />9. Does Representative of 17ntity 14ish to be Present? 2 S <br />10. If so, 'c'hat is his name, title ...._ ::e:: .:~:•l,:r"_~p/J-- urGc~~2 -- <br />11. Do they wish to split sany~les? YZ S <br />12. If so, will they pxrovide container? e s <br />13. What arrangements have been made to meet representative and/or ga n entrance to <br />facilities: <br />14. Parameters to be moaitored: BOD Suspended Solids . D.OL pH <br />Fecal Oolifoim Temperature Turbidity Chlorine ideal <br />Oil & Grilse O1Hf1?,S (list): ~'~ ~~i p ~Y~~j De HoISTCt2e <br /> <br />15. Type of sample (grab or coaPOSite,'describe)? <br />16. Special containers or presetvatives? L Q C OIJY" ~ <br />17. Persons present during sanoling (names & titles): <br />18. Was sample spli <br />19. Who received or <br /> <br /> <br />rt~aur~ <br />-t~ <br />Note: If laborator anal sis f h I <br />Quality Control Acf~" rf~PSP rPSUlrs ma be used, in the future, for .nforcement actions. <br />