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.:~ • <br />Q3I11?ADO DEPARTMFSII` OF HEALTH <br />water Quality Control Division <br />• <br />I,AB. NUtd~R: <br />1•~OM {VATF~t QUALITY DATA SHEET <br />rT"rDRi:Er.:.T .l'U~r'il:;l{I:<<i 17iC1' S}il:iil' <br />1. Name of entity: S.a,~ Luls FRc~~ 2. Peinnt ~: r2-gE"~ ~ a- <br />3. Date of Oontact: .~-/(-q~ 4. Time of Contact: 7:30 <br />5. Person contacted (name & title): ~{1[,} 266e-/+`ISaAi <br />6. Phone No. where he can be reached: 7. Contact by: <br />8. Date of Scheduled Sanpling: j-!(-~? <br />9. Does Representative of Entity SYish to be Present? <br />10. If so, `a~hat is his a~ai~c, titi: :;.: .. -•:?::~:~'^--------------------- <br />11. m they wish to split samples? ~jeS`- <br />12. If ~, will they provide container? ~ e5 <br />]-3. what ar,-a.,Henents have been made to rmet r~r~entative and/or gain entrance to the <br />facilities: , <br />14. Parameters to be monitored: BQD Suspended Solids D.O., pH <br />Fecal Golifoim Temperature Turbidity Chlorine Residual <br />Oil & Grease OTHERS (list) : ~~_L ~~ /.J i l~ 2. <br />15. Type of sample (grab or cite, 'describe)? G/Zq.Q So[L 5/i-+~6[.e <br />16. Special containers or preservatives? p <br />17. Persons present during saimling (names & titles): <br />18. was sample spli <br />19. who received or <br />20. <br /> <br />