_GENERAL DOCUMENTS - C1981017 ‎(205)‎

• Permit No: C1981017
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Name: Bid Documents ‎(IMP)‎
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

COLORADO DEPARTMENT OF HEALTH Water Lab No.
Water Quality Control Division (From Water Qua . Data Sheet
(Sample Collected by MLRD)
ENFORCEMENT MONITORING FACT SHEET
1 . Name of Company: 2. NPDES Permit#:
2a. Name of Mine: 2b. MLRD Permit#:
3. Date of Contact: 4. Time of Contact:
5. Mine contact/title/address:
6. Phone: 7. Inspector/Sampler:
8. Date anF7T'1m­e7—oT Sampling:
9. Does Mine Representative wish to be present? :
10. If so, list name, title, and phone:
11. Does the Operator wish a sample split? Initials:
12. Will the Operator provide container? Initials:
13. Are there any special arrangements to meet at site?
14. Parameters to be Monitored: Total Suspended Solids pH
Temperature Settleable Solids Iron Manganese
Other (list) :
15. Type of Sample: Grab Composite Describe location sample was
taken:
16. Containers: Plastic containers w/o acid Size:
Plastic containers acidified w/HNO3 Size:
Other:
17. Name & Title of Persons Present During Sampling:
18. Was sample split?
19. Who Received or Denie Sp it Name,Title, Initials) :
20. Disposition of sample after collection:
Transferred From: To: Time/Date:
Transferred From: To: Time/Date:
Transferred From: To: Time/Date:
Transferred From: To: Time/Date:
Received at Lab by: Time/Date:
Comments:
Note: If Laboratory analysis of the above mentioned sample -indicates a
violation of the "Water Quality Control Act" , or other State or Federal water
quality Laws, these results may be used in the future for enforcement actions.
Signature of Sampler:
Doc. # 8683F-B