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t Drtc~ ~~~~~~~ <br />CAIlJRADO DEPAKIMIIVT OF HEA~ ~. :~~Uo96 <br />Water Quality Control Division FROM WA I QUALITY DATA SHEEP <br />U <br />~'~~~~~ , <br />/~~ 3/ <br />1. Name of Entity:~nJ__ <br />3. Date of Cbntacta ~A~N <br />5. Person contacted (name ! <br /> <br />2. Permit #: h' $8` n3-- <br />4. Time of Cpntact : q ~ c, p <br />6. Phone No. where he can be reached: -7 ~Y- 67a-~! <br />8. Date of Scheduled SaJ~ling: Jgns~.eg-2~p l~ ~~ <br />9. Does Representative of Entity Wish to be Present <br />1~. If so. ~~9iai is his .rlJn~, .`_~ ~ ., <br />11. Do they ~rzsh to split sa:t7~les~ Sp~[r $.+~p-{p«W~}5 ~y{ice S, <br />12. If so, will they provide container? atis'rtF' PRov' rz <br />].3. RlJat arran~r3nents have 'men nude to nx"~*, rF~nreG?ntative and/or ear entrance to the <br />facilities: <br />14. Parameters to be rmnitored: EOD Suspended Solids D.O. pH <br />Fecal Coliform Tanperature Turbidity Chlorine idual <br />Oil & Grease CIII~tS (list): W~p L°~1Rl~7l~E.~7bZi3L C rt~2 CO-t~lc. <br />15. Type of sample (grab or canposite, 'describe)? GR2,t4g 5.4atpcei <br />16. Special containers or preservatives? f!E} e2 W L ~~ ~r N <br />PLtISTcc, /~ c,l,c.lte'T <br />17. Persons present during sarrmling (names & titles): <br />18. Was sample split? ~ <br />19. Who received or denie <br />20 <br />t (name & <br />~_~r•rn.~ r~.v •~~r~ ~ ~ orv . r-~ r rw /'G I-tNrttK _K I <br />Disposition of sample after collection: ~e w r+c, t~ !~ <br />~_ r!i ~ G G Oe c R <br />~ e i E' U crc. <br />-~7 'T-"~ Q T <br /> <br /> <br />