HomeMy WebLinkAbout23-M005661 AmTest Laboratories
13600 NE 126th PL STE C, Kirkland, WA 98034
425-885-1664 www.amtestlab.com
COLIFORM BACTERIA ANALYSIS
Date Sample Collected Time Sample County:
10/23/2023 Collected � AM
Month Day Year 12:50 � PM KING
Type of Water System (check only one box)
� Group A Public� Group B Public
� Private Household� Other: __________________
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
ID# 71850L
System Name: CITY OF RENTON: CANOPY PROJ
Contact Person: ABDOUL GAFOUR
Day Phone: 425 430 7210 Cell Phone:
Eve. Phone:FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOUL GAFOUR
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected by (name): KIP BRAATEN
Specific location where sample collected:
HYD #1 ON LINCOLN AVE NE (2)
Project Name or Comments: CANOPY
Type of Sample (select only one type of sample from types 1 through 5 below)
1. � Routine Distribution Sample
Chlorinated: � Yes � No
Chlorine Residual: Total____ Free____
2. Repeat Sample (after unsat. routine) � Distribution System
� Source Groundwater Rule (GWR)
(Population of 1,000 or less)
3. Ground Water Rule Source Sample
|__S__|_____|_____|
� Triggered (A/P)
� Assessment (A/P)
Unsatisfactory routine lab number:
____ ____ ____ ____ ____ ____ ____ ____Unsatisfactory routine collect date:
________/________/________Chlorinated: Yes_______ No_______Chlorine Resid: Total______ Free_______
4. Surface or GWI Raw Water Sample (Enumeration)
� E. coli � Fecal Filtered Yes___ No___ |__S__|_____|_____|
5. Sample Collected for Information Only
� Construction � Repairs � Private Residence � Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
� Unsatisfactory
Total Coliform Present and Satisfactory
� E. coli present � E. coli absent
Replacement Sample Required
Sample not tested because
� Sample too old (>30 hours)
� Improper Container
� ____________________________
Test unsuitable because:
� TNTC
� Turbid Culture
� ____________________________
Bacterial Density Results:
Plate Count / ml. E.coli /100 ml.
Total Coliform /100 ml. Fecal Coliform /100 ml.
Method Code: SM 9223B Date Received: 10/23/2023
Date Analyzed: 10/23/2023, 13:50 Date Reported: 10/24/23
066-05661
Sample Number (DOH number plus five digits)
Lab Use Only:
DOH Form #331-319 (revised 02/16)