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~ ~ i. <br />ao~nRADO D~ASn~rrr of RFALTH rns..N[B~2t: <br />Water Quality (bntrol Division FROM {YA'~R QUALITY DATA SF~f <br />~l?R(;E:,::~T .lYJirIIUl{Ltiti TaCl' St;L:ul' <br />1. Name of Eatity:~ <br />3. Date of Q~ntaat:_L <br />5. Person contacted (name F <br />6. Phone No. where he can be reached: 7~9-G,7~ 4~f~ <br />8. Date of Scheduled Sampling: /-~.~ -~'s'7 <br />9. Does Representative of Entity Wish to be Present? <br />10. If so, what is his Name, titi:' ...._ ::~::. ,:.~r:r?_ <br />2. Permit u: M"-g$ l ~c~ <br />4 . Time of iCbntact : p g3 <br />Il. Ib they wish to split samples? Ye S <br />12. If so, will they pxbvide container? <br />13. What arc~ageaents have been Trade to myet re:u~esentative and/or in entrance to the <br />facilities: <br />14. Parameters to be monitored: BOD Suspended Solids D. pH <br />Fecal doliform Teq~eratin'e Turbidity Chlorine idual <br />Oil & Grease 171HIltS (list): ~-~hL~~y~A hIo 5 <br />! 15. Type of sample (grab or composite, <br />-~ tJ/~2t~er+.ti~ 'he~l'YaS , Fker <br />16. Special containers or preservatives? L C:~ <br />17. Persons preseat ding sampling (names & titles): <br />©Atc7 12af~P~2~i~~ MYhT2 F i,Q~hu}{-2~t2 <br />18. Was sample spli <br />19. Who received or <br />i <br />;.1 .r <br />I <br />20. <br />xaan[uis: <br />