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~ iii iiiiiiiiuiiiiii ~ <br />. ~- <br />paIl~tADO DEPAK11~Nr aF HEALTH LAB. . <br />water Quality (bntrol Division FIlpM 1QUALITY DATA SHEEP <br />r`Iv`i~~Ri;En"::~T ~~iiil.i:II~~; FACT' SHl~il' <br />6. <br />8. <br />9. <br />10. <br />1. Name of Eatity: ~~} <br />3. Date of (batact:_L <br />5. Person contacted (nam <br />2. Permit {/:irl-g$-/~Z <br />4. Time of gontact:_!l~ ¢~ <br />Phone No. where he can be reached: 7. (bntact by: <br />Date of Scheduled Sampling: !-a9 -4'] <br />Does Representative of Entity wish to be Present? <br />If SO, what 1S h1S ?L3I'1C, tit1P :1:.' ;.~~•:: .: •:•<~=?'?_ ~~ (~ LT __-- <br />11. Do they wish to split samples? `1~~ ~ <br />12. If ~, will they provide container? ~~ 5 <br />13. what arrangements have been made to meet representative and/or ga' entrance to <br />facilities: <br />14. Parameters to be monitored: BQD Suspended Solids D.O. pH <br />Fecal Gbliform Temperattme T~mbidity Q~lorine Relsidual <br />oil & case o~xs (list): ~~. ~i~~Q! STu.R.e <br />15. Type of sample (grab or composite, describe)? ~ Rn /.e, <br />1S. Special oontaaners or preservatives? L <br />17 <br />18. was sample spli <br />19. Who received ar <br />20 <br />R):2dAI?K.S: <br />s11~ rt P C.e ~ ~" F <br />Note: If laboratory analysis of the about menr' e~ mple ~' WI I vin]-•~^^ ^F the "W- <br />QU21~MY ~~n•T4~ I~f1f~~ Y{\PSP res~~l.s maV do VSe~,_nn she ~i~-i~rPi fnr nrnF~n2 aGt ions. <br />