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COLORADO DEPARTMENT OF HEALTH Water Lab No. <br /> Water Quality Control Division (From Water Qual . Data heet <br /> (Sample Collected by MLRD) <br /> ENFORCEMENT MONITORING FACT SHEET <br /> 1 . Name of Company: t(v -o-f-2. NPDES Permit#: <br /> 2a. Name of Mine: r'At , 2b. MLRD Permit#: C ` ' <br /> 3. Date of Contact: �! •(,, �1 4. Time of Contact: r<+. <br /> 5. Mine contact/title/address: i �, !r► . �_.r, kt , �_ i.,v! t'rr,i�� r,>a� t r,r�i ��,i' i <br /> 6. Phone: 7. Inspector Sampler: <br /> 8. Date and Time of Sampling: <br /> 9. Does Mine Representative wish to be present?: IUA< <br /> 10. If so, list name, title, and phone: i) t?l- <br /> 11. <br /> Does the Operator wish a sample split? XJ� Initials: <br /> 12. Will the Operator provide container? Nn 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 V Iron anganese <br /> Other (list) : <br /> 15. Type of Sample: Grab V Composite Describe ocation sample was <br /> taken: Ctc 0 0'r1 t,v- P i b% <br /> 16. Containers: Plastic containers w/o acid Size: <br /> Plastic containers acidified w/HNO3 Size: <br /> Other: SAMP ' k) <br /> 17. Name & Title of Persons Present During Sam? in9: Ztw 11--V)t A) AA ' ; -,ri <br /> 18. Was sample split? yF <br /> 19. Who Received or Denie p it Name,Tit e, Initials) : <br /> 20. Disposition of sample after collection: I C� �1 f A,» r) 'cam <br /> ! AR <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 />