ENFORCE30881

• Permit No: C1982057
• IBM Index Class Name: Enforcement
• Doc Name: MONITORING FACT SHEET FIELD SAMPLING
• Violation No.: CV1997015
• Media Type: D
• Archive: No

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COLORADO DEPARTMENT OF HEALTH Water Lab No.
Water Quality Control Division (From Water Qua ata heet
{Sample Collected by MLRD)
ENFORCEMENT MONITORING FACT SHEET
1. Name of Company: 2. NPDES Permit#:
2a. Name of Mine: 2b. MLRD Permit#:
3. Date of Contact: 4. Time of Contact:
5. Mine contact/title a ress:
6. Phone: 7. Inspector/Sampler:
8. Date and Time of Sampling:
9. Does Mine Representative wish to be present?:
10. If so, list name, title, and phone:
. Does the Operator wish a sample sp it? Initials:
12. Will the Operator provide container? Initials:
13. Are there any special arrangements to meet at site?
14. Parameters to be Monitored: Total Suspended Solids pH
Temperature Settleable Solids Iron -Ffanganese
Other (list):
15. Composite
Describe
Type of Sample: Grab ocation samp a was
_
_
taken•

16. Plastic containers w/o acid
Containers: Size:
_
Plastic containers acidified w/HN03 Size:
_
Other:
17. Name & Title of Persons Present During Sampling:
iu. was sample spiiti:
19. Who Received or Denie Sp it Name,Tit e, Initia s
20. Disposition of sample after collection:
ransferred From: To: Time/Date:
Transferred From: To: Time/Date:
Transferred From: To: Time/Date:
Transferred From: To: Time/Date:
Received at Lab by: Time/Date:
Comments:
Note: La oratory ana ysis o t e above mentione samp a in icates a
violation of the "Water Quality Control Act", or other State or Federal water
quality Laws, these results may be used in the future for enforcement actions.
Signature of Sampler:
Doc. # 8683E-B