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06-096DEPARTMENT OF ENVIRONMENTAL PROTECTION

12.If problems with water quality are indicated, please describe:

13.Was the water quality test requested by the resident?  If yes, please state the reason for the request.

14.Additional comments:

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DO NOT WRITE BELOW THIS LINE (FOR DEPARTMENT USE ONLY)

Project Name:_________________________ Date of sample collection:____________

ANALYSIS REPORT

Date results received:_______________________

Satisfactory:______________________________

Unsatisfactory:____________________________

Further investigation warranted? ____ yes____ no

Recommended action: _______________________________________________________________________

_______________________________________________________________________

Chapter 405: Water Quality Monitoring, Leachate Monitoring, and Waste Characterization

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