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,J <br />O~tADO DFPARIMINC OF $FALTH <br />Water Quality (bntrol Division <br />c~'r11Ri:E+%::~T .lYkvIlDliL'iii I'AC1' SHlii:l' <br />.;c <br />1. <br />3. <br />5. <br />Name of Eatity:_ <br />Date of (bntact: <br />Person contacted <br />s. Phone No. where be can be reached:~'~q-G,7~ 4f,~ <br />8. Date of Scheduled Sampling: 1-elQ -~i''7 <br />9. Does Representative of Fhtity Wish to be Present? <br />10. If so, what is his a~ar.~e, titi~ ::::.' , ,.. -. .: ~:~+~=r?_ <br />11. Do they wish to split sarrPles? Y~ S <br />12. If so, will they provide container?_f 2 <br />13. What arranganents have been made to meet <br />facilities: <br />i <br />LAB..N[&lBF1?: <br />FRfJM lYA'~R QUALITY DATA SEi~T <br />ve <br />Permit ~: e-~- SS l ~a <br />Time of !(bntact: pg3® <br />entrance to <br />14. Parameters to be monitored: B(ID Suspended Solids D. pH <br />Fecal (bliform Temperature Turbidity Chlorine idual <br />Oil & Grease OARS (list): ~~ @GY4IJ~A~y (~ [}~ Ko 5 <br />L5. Type of sample (grab or composite, <br />16. Special containers or preservatives? L G`~ <br />17. Persons present during sa~liog (names & titles): <br />1~~ 7 n.~ P><t H rare. M.4~n~A-~-~e~a2 <br />18. Was sample spli <br />19. Who received or <br />20. <br />i ~ _ <br />1 <br />,. <br />~~: <br />