<p> COLORADO WATER QUALITY MONITORING COUNCIL COLORADO DATA SHARING NETWORK P.O. Box 2058 Ridgway, CO 81432 • 970-626-4045 [email protected] • www.ColoradoWaterData.org</p><p>CDSN Data Provider New Organization Credentials Request Form | August 2013</p><p>This form must be completed at the time that a new Organization login and password is requested for the CDSN data management system. An example of a correctly completed form is provided on Page 2. Type in the boxes below: ORGANIZATION NAME DESCRIPTION OF ORGANIZATION ADDRESS (INCLUDE MAILING IF DIFFERENT FROM PHYSICAL) PHONE FAX EMAIL WEB ADDRESS + CONTACT PERSON (INCLUDE ADDRESS/PHONE/EMAIL IF DIFFERENT FROM ORGANIZATION) TYPE(S) OF DATA (e.g. water quality, macroinvertebrate, pebble, etc.) 319 Grant? If yes, years & CDPHE contact REG 85 PARTICIPANT? Tier? EPA/GS ORG ID, USERNAME & PASSWORD [ADMINISTRATIVE USE ONLY] DATE ORG ID/U/P ISSUED: [ADMINISTRATIVE USE ONLY] OTHER PEOPLE WORKING WITH THIS PROJECT THAT HAVE THE USERNAME 8/1/2013 & PASSWORD:</p><p>Example of Completed Form: ORGANIZATION NAME Arkansas Headwaters Recreation Area (AHRA) The Arkansas Headwaters Recreation Area (AHRA) is a Colorado State Park in the Upper Arkansas River Valley and is recognized as one of the nation's most popular locations for whitewater rafting and kayaking on the Arkansas River - the most DESCRIPTION OF ORGANIZATION commercially rafted river in the United States. ADDRESS (INCLUDE MAILING IF DIFFERENT FROM PHYSICAL) Mailing & Physical Address: 307 W. Sackett Ave. Salida, CO 81201 PHONE 719-539-7289 FAX 719-539-3771 EMAIL [email protected] WEB ADDRESS + http://www.parks.state.co.us/Parks/ArkansasHeadwaters/Pages/ArkansasHeadwatersHome.aspx CONTACT PERSON (INCLUDE ADDRESS/PHONE/EMAIL IF DIFFERENT FROM ORGANIZATION) Rob White, Park Manager TYPE(S) OF DATA (e.g. water quality, macroinvertebrate, pebble, etc.) Water quality, macroinvertebrate, geomorphology (x-sections), vegetation (PFC), photos 319 Grant? If yes, years & CDPHE contact Yes, funded 2007, CDPHE contact = Curtis Hartenstine REG 85 PARTICIPANT? Tier? Yes, Tier 1 EPA/GS ORG ID, USERNAME & PASSWORD [ADMINISTRATIVE USE ONLY] DATE ORG ID/U/P ISSUED: [ADMINISTRATIVE USE ONLY] OTHER PEOPLE WORKING WITH THIS PROJECT THAT HAVE THE USERNAME & PASSWORD: Michael Blazewicz (CWA MRP 2012); </p><p>Page 2</p>