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' I <br /> COLORADO DEPARTMENT OF HEALTH Water Lab No. <br /> Water Quality Control Division (From Water Qua . Data Sheet <br /> (Sample Collected by MLRD) <br /> ENFORCEMENT MONITORING FACT SHEET <br /> 1 . Name of Company: 2. NPDES Permit#: <br /> 2a. Name of Mine: 2b. MLRD Permit#: <br /> 3. Date of Contact: 4. Time of Contact: <br /> 5. Mine contact/title/address: <br /> 6. Phone: 7. Inspector/Sampler: <br /> 8. Date and Time of Sampling: <br /> 9. Does Mine Representative wish to be present? : <br /> 10. If so, list name, title, and phone: <br /> 11. Does the Operator wish a sample split? Initials: <br /> 12. Will the Operator provide container? Initials: <br /> 13. Are there any special arrangements to meet at site? <br /> 14. Parameters to be Monitored: Total Suspended Solids pH <br /> Temperature Settleable Solids Iron Manganese <br /> Other (list) : <br /> 15. Type of Sample: Grab Composite Describe location sample was <br /> taken: <br /> 16. Containers: Plastic containers w/o acid Size: <br /> Plastic containers acidified w/HNO3 Size: <br /> Other: <br /> 17. Name & Title of Persons Present During Sampling: <br /> 18. Was sample split? <br /> 19. Who Received or Denied Sp it Name,Title, Initials) : <br /> 20. Disposition of sample after collection: <br /> Transferred From: To: Time/Date: <br /> Transferred From: To: Time/Date: <br /> Transferred From: To: Time/Date: <br /> Transferred From: To: Time/Date: <br /> Received at Lab by: Time/Date: <br /> Comments: <br /> Note: If Laboratory analysis of the above mentioned sample indicates a <br /> violation of the "Water Quality Control Act", or other State or Federal water <br /> quality Laws, these results may be used in the future for enforcement actions. <br /> Signature of Sampler: <br /> Doc. # 8683F-B <br />