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O~2AD0 DFPARZI~1'1' C~' IIEAL'iH <br />Water Quality Control Division <br />t`Iv'rURi:Ea".;.T LYA4iTU1iL'W~ 1~AC1' Slila:l' <br />1. Name of Eatity: <br />3. Date of Q~atact <br />5. Pierson oontacte <br />6. Rhone No. where he can be reached: 719~~7~ 4J1 <br />8. Date of Schechiled Sampling: !-a..4 '? <br />9. Does Representative of Entity {4ish to be Present? <br />10. If ~, what is his ttar~e, title ...._ , ... -. .: ~:;r:r' <br />11. Do they wish to split sartq~les? Y~ S <br />12. If so, mill they provide ccntainer?~ <br />13. What arrangenents have been made to meet <br />facilities: <br />1 <br />f <br />LAS..N[R~BIIt: <br />FR(JM {4A'1~R QUALITY DATA SHEEP <br />Z. Pe>.mit ~~-~S l~~ <br />4. Time of ntact: p g3 p <br />ve <br />by: <br />14. Parameters to be monitored: BaD Suspended Solids D <br />Fecal Ooliform Tenperatta'e Turbidity (]~lorine <br />Oil & Grease Offi~R.S (list) : 'mv-z~ ~gpZ~1Jg~~'A Sa <br />15. Type of sample (grab or ccmpasite, <br />1&. <br />or <br />PH <br />17. Persons present during samplitg (names & titles): ~ <br />Atl 7 2.at~ Pa2.~n ~ M vile. 1"FA~+l~~otZ <br /> <br />18. Was sample spli <br />19. Who received ar <br />20. <br />RadARKS: <br />.*~!. <br />~V ~44~rn~ AC~~ _^''1PSP rPSi~'~5 m~~/ }P n5P/~~ iin t~'}_P f11Y 1J IMP. nfOf, <br />L~ <br />the ..L <br />ions- <br />