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~ III IIIIIIIIIIIII IIl~-a- ~~ g ~~ ~ ~o <br />Q?UItADO DIPAFr1MENP ~ HFAI.TH LAB..N[ME~fR: <br />Water Quality Q~ntrol Division FR(1N {VAR QUAI,Pi'Y DATA S1iF.Er <br />r <br />rT'rURi:Eri:~T kUiv~lUltIi~G lACl' St11:131' <br />1. <br />3. <br />5. <br />Name of Eatity:_ <br />Date of dJnta,ct: <br />Person contacted <br />6. Phone No, where he can be reached: 714-L,7~ 4~ <br />8. Date of Sche~aled Sampling: 1-el;~ -~','Z, <br />9. Does HepQ~eseatative of Entity Wish to be Present <br />10. If ~, what is his ate, title :..._ , ~::e:: ::~~•~-,•:r? <br />11. Do they wish to split samples? ~{p S <br />12. If so, will they provide container?~~ <br />13. What arrangements have been made to treet <br />facilities: <br />14 <br />15. Type of sample (grab or comiposite, <br />]6. <br />Pbimit t,~:~" =gg % low <br />Time of ~.bntact: pg3p <br />17. Persons present ding samplimg (names & titles): <br />~/M 7 2.tsf_3 Pv2'7`~n ~ M 1~2. >"'t.4l~SA~'~Z <br />18. Was sample spli <br />19. Who received or <br /> <br />20. <br />RF7.IARILR <br />Parameters to be monitored: BCID Suspended Solids D.d. pH <br />Fecal Gblifoxm Temperatiu^e Turbidity Chlorine idual <br />Oil & Gt~ease ODORS (list): ~fR~YanI17Jg~A fto STU~_ <br />