Providence Point Water Sampling Report

• Conducted on

  Date

• Prepared by

  Sign

I certify under the penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

• Inspection Type

  Yes

  No

  N/A

• Rainfall Amount (Inches)

• Last Storm Start Datre

  Date

• Last Storm End Date

  Date

• Gordy Adams

  Sign

• Sample Point Location #1 - Manual Grab (per plans) completed by Gordy Adams

  Date

• Analysis completed by Gordy Adams

  Date

• EPA 180.1 Analysis Data Results (NTUs)

• Sample Point Location #2 - Manual Grab (per plans) completed by Gordy Adams

  Date

• Analysis completed by Gordy Adams

  Date

• EPA 180.1 Analysis Data Results (NTUs)

• Comments