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HomeMy WebLinkAboutWTR2703142_5ISO zy- O o � 1 � 1 v —�I 1 -)' - l ' I v $10 aS-o3,Qq bur --� � h� L jc(I�o--.sty,+`'sr C�� !SaA C/ (� ✓' T4 if le, Pt W u 1 �o d- c i I'lac- C 7 n ------_-_- — ----- - � J c 1 fh,V f 1 r � r v i i ®�-03_011 _ G4�5.S 3osL, s s Au 9v 3ci f�13 Tt v, So I i 00 O 'G on '�" �Gyc. A V .-i-J i► ; if eoi " t 1 frIji- ^s C. / ✓L s ZYII I !:/ lot AL M �I �� D V6 M� h i I � is• l Sw � rA ` T f� I 1 V v L 2 M 77` Cl r.o P t M C V+ ��; �ia5 !� �x 9 Gv oufi) V d 9ve�4 0 T✓4 ��h qA ! - 1GF L 'l V d� 2 , i 7 ll ye I l 9- 1 6- dL/ F lk 0 7 - Gi L Y; c - Jo 5 4 _ 1 l I f 1 I ! f I I i J 6 I 8`'p� C rGw• � T --- ` 1 y elf - - r _ DI i p Sw irw - r5c - l'2 : !C•c - �os ----------------- D -- VOL 271 _ 6 Al I 67 ZO- aty 5 1- "h d 'bwvrf� i coo _70- • .lt wefT -fie r -# f 4.v Pave T 6V -4k qo-: 114 tea= ........ . . SP' g 34M "X'Lt IT, �, NO 1 i /14 i d � c � vs lss �c;s? Laucks Testing Laboratories, Inc. 940 S. Harney Seattle. WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED I TIME COLLECTED I COUNTY NAME MONTH , DAY YEAR AM PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: PUBLIC INDIVIDUAL I.D, N0. 71 CIRCLE GROUP (serves only 1 residence) A B NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED SAMPLE COLLECTED BY: (Name) TELEPHONE NO. DAY ( ) EVENING ( ) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE U GROUNDWATER UNDFR ci n.�ocr lr:r ovvc SURFACE F_1 or D SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) IE OF SAMPLE (check only one in this column) ❑ ROUTINE Chlorinated (Residual: Total — Freei DRINKING WATER check treatment Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date / RAW SOURCE WATER Source # FS] m ❑ Total Coliform ❑ NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS UNSATISFACTORY, Coliforms present SATISFACTORY, Coliforms absent REPEAT ❑ E. Coli present ❑ E. Coli absent SAMPLES REQUIRED Fecal present Fecal absent OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml /00 M� I` E COUNTml FECAL COLIFORM / CEV ANOTHER SAMPLEORQUIRED 2 2 2O SAMPLE NOT TESTED BECALV:L TEST UNSUITABLE BECAUSE: Sample too old CITY OF RENTO_n Confluent growth Wrong container L)TIl SYSTtMS❑ TNTC ❑ Incomplete form Turbid culture ❑ Excess debris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY DATE REPORTED LABORATORY: REMARKS DOH 305 002 (REV 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure 4he safety of the water supply. 1 N0^T10TAli 1 VM i r1Lal3LTj. Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples„ submitted_ Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample. the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systerns as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous rnass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within. 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED I TIME COLLECTED COUNTY NAME MONTH , DAY YEAR ❑ AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: ❑ PUBLIC ❑ INDIVIDUAL LD. N0. CIRCALE GB UP (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. DAY ( I SAMPLE COLLECTED BY: (Name) EVENING ( ) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE "GROUNDWATER UNDER SURFACE INFLUENCE ❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) wncuiunrnni TYPE OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: Total _ - Free) DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date ❑ RAW SOURCE WATER Source # F m ❑ Total Coliform ❑ NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: 1 A ; � (2 _ _ 1 -7 (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present Q SATISFACTORY, Coliforms absent REPEAT ❑ E. Coli present ❑ E. Coll absent SAMPLES Fecal present Fecal absent REQUIRED ❑ ❑ OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml E. COLI /100 ML FECAL COLIFORM /100 ml PLATE COUNT /ml ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE: ❑ Confluent growth ❑ Sample too old 1'EN �CO ❑ Wrong container 1/ ❑ TNTC ❑ Incomplete form ❑ Turbid culture ElJUL 22 2004 ❑ Excess debris SEE REVERSE SIDE O"RBELU"(r PLANATION OF RESULTS LAB NO. (7 DIGITS) A kc/VED I RECEIVED BY (DATE REPORTED I LABORATORY: REMARKS DOH 305 002 (REV. 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480, SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED I TIME COLLECTED I COUNTY NAME MONTH , DAY .YEAR �. I P AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: PUBLIC CIRCLE GROUP ❑ INDIVIDUAL LD. No. A B (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. DAY �+ EVENING SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE ❑ GROUND WATER UNDER SURFACE INFLUENCE ❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) TYPE OF SAMPLE (check only one in this column) ❑ ROUTINE Chlorinated (Residual: Total Free) DRINKING WATER ❑ check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date ❑ RAW SOURCE WATER Source # Fs] m ❑ Total Coliform NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑,SATISFACTORY, REPEAT ❑ E. Coli present E]E. Coli absent Coliforms absent SAMPLES ❑ REQUIRED Fecal resent Fecal absent ❑ p OTHER LABORATORY RESULTS TOTAL COLIFORM _ /100 ml E. COLI /100 ML FECAL COLIFORM /100 ml PLATE COUNT /ml ANOTHER SAAt-PCO �pED L'L��YY SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE: lent growth ❑ Sample too old JUL RTNTC L ❑ Wrong container -T�n���� ❑ Incomplete form CITY O P ure ❑ UTILITY1'&cess debris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY DATE REPORTED LABORATORY: REMARKS DOH 305 002 (REV. 4192) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of colifonn organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED TIME COLLECTED COUNTY NAME MONTH DAY YEAR AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: Q PUBLIC CIRC ❑ INDIVIDUAL I.D. N0. ALE GROUP (serves only i residence) ❑ - .- NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. DAY t l EVENING ( ) SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.: (Name) v SOURCE TYPE GROUND WATER UNDER SURFACE INFLUENCE ❑ SURFACE DWELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) f 'E OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: Total Free) DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date ❑ RAW SOURCE WATER Source # IS] ❑ ❑ Total Coliform NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑ SATISFACTORY, Coliforms absent REPEAT ❑ E. Coli present ❑ E. Coli absent SAMPLES nt Fecal absent REQUIRED Fecal present ❑ ❑ OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml E. COLI /100 MIL FECAL COLIFORM /100 ml PLATE COUNT /ml ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTED BECAUSE: REG/TLu'J� VEF: LE BECAUSE: ❑ Sample too old Confluent growth ❑ Wrong container JUL EZqn ❑ Incomplete form culture ❑ CITY Oa"%glgbris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. (7 DIGITS) DATE. TIME RECEIVED RECEIVED 7BY i DATE REPORTED LABORATORY: REMARKS DOH 305 002 (REV. 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle. WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED I TIME COLLECTED I COUNTY NAME MONTH . DAY YEAR ❑ AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: PUBLIC ❑ INDIVIDUAL I.D. N0. CIRCAB LE GROUP (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. DAY( ) SAMPLE COLLECTED BY: (Name) EVENING ( ) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE U GROUNDWATER UNDER SURFACE INFLUENCE ❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) PE OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: Total _ Free) DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date / ❑ RAW SOURCE WATER Source # Is] m ❑ NEW CONSTRUCTION or REPAIRS ❑ OTHER (Specify) REMARKS: ❑ Total Coliform ❑ Fecal Coliform (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑ SATISFACTORY. REPEAT ❑ E. Coli present E]E. Coli absent Coliforms absent SAMPLES REQUIRED ❑ Fecal present ❑ Fecal absent OTHER LABORATORY RESULTS TOTAL COLIFORM A 00 ml E. COLI _ /100 ML FECAL COLI FORM /100 ml RECEVED/ml ANOTHER SAMPLE REQUIRED ��%%[[�����I}} SAMPLE NOT TESTED BECAUSE: JULTE_6nI�UCfd3C/ITABLE BECAUSE: ❑ Sample too old CITY C�Figydfgrowth %yl'�-MvS ❑ Wrong container CITILITL 1L1 ❑ Incomplete form ❑ Turbid culture ❑ ❑ Excess debris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY DATE REPORTED LABORATORY: }r REMARKS DOH 305 002 (REV. 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480, SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED I TIME COLLECTED I COUNTY NAME MONTH , DAY .YEAR AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: PUBLIC ❑ INDIVIDUAL I.D. N0. CIRCLE GROUP A B (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. DAY ( ) SAMPLE COLLECTED BY: (Name) EVENING ( ) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE U GROUND WATER UNDER SURFACE INFLUENCE ❑ SURFACE 0 WELL or ❑ SPRING PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) TYPE OF SAMPLE (check only one in this column) ❑ ROUTINE Chlorinated (Residual: _Total _ Free) DRINKING WATER check treatment Filtered Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date RAW SOURCE WATER Source # IS] m ❑ Total Coliform NEW CONSTRUCTION or REPAIRS Fecal Coliform OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present E] SATISFACTORY, REPEAT ❑ E. Coli present E. Coll absent Coliforms absent SAMPLES REQUIRED F-] Fecalpresent resent Fecal absent OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml E. COLI /100 MIL FECAL COLIFORM /100 ml PLATE COUNT /ml ANOTHE TitL SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE: JULSample Z0(N too old Confluent growth Wrong container TN�T�C CITY OF RE lbid culture ❑ Incomplete form UTILITY SYST - � ❑ xcess debris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY F 7 /T .�� DATE REPORTED LABORATORY: ` REMARKS DOH 305 002 (REV. 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatistactory samples should be investigated IMMEDI- ATELY and reDe-.at samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480, 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED TIME COLLECTED COUNTY NAME MONTH DAY YEAR AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: PUBLIC ❑ INDIVIDUAL LD. N0. CIRCALE GROUP (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. F DAY i EVENING SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE ❑ GROUND WATER UNDER SURFACE INFLUENCE ❑ SURFACE Q WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) 'E OF SAMPLE (check only one in this column) ❑ ROUTINE Chlorinated (Residual: Total Free) DRINKING WATER ❑ check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date ❑ RAW SOURCE WATER Source # Fs] m ❑ Total Coliform ❑ NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present EISATISFACTORY, �Coliforms absent REPEAT E. Coli present E. Coli absent SAMPLES Fecal resent Fecal absent REQUIRED ❑ P ❑ OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml E. COLI /100 ML FECAL COLI FORM /100 ml PLATE COUNT /ml ANOTHER SA R QUEEIREvvD SAMPLE NOT TESTED BECAUSE: 91YEDABLE BECAUSE: ❑ Sample too old growth JUL � ��gfluent ❑ Wrong container lIII�C ❑ Incomplete form CITY OF YiNulture ElUTILITY U� debris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB N0. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY DATE REPORTED LABORATORY: REMARKS DOH 305 002 (REV. 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DON Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480, TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked. the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to. be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED TIME COLLECTED COUNTY NAME MONTH DAY YEAR Q AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: PUBLIC ❑ INDIVIDUAL I.D. N0. CIRCALE GB UP (serves only 1 residence) _ NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE ` ❑GROUND WATER UNDER SURFACE INFLUENCE ❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) )E OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: _Total Free) DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date ❑ RAW SOURCE WATER Source # Fs] m ❑ Total Coliform NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑ SATISFACTORY, Coliforms absent REPEAT ❑ E. Coli present ❑ E. Coli absent SAMPLES l ecaresent Fecal absent F � p ❑ REQUIRED OTHER LABORATORY RESULTS TOTAL COLIFORM _ A00 ml E. COLI /100 ML FECAL COLIFORM /100 mlaFma /ml ANOTHER L Th(�l7�ff�, SAMPLE NOT TESTED BECAUSE: JUL 2 2T�747FJSUITABLE BECAUSE: ❑ Sample too oldlNent growth ❑ Wrong container CITY OF YOZ SY ❑ Incomplete form UTILITY Turbid culture ❑ ❑ Excess debris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB N0. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY lit DATE REPORTED LABORATORY: REMARKS DOH 305 002 (REV. 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample. the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health. Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. I MODATE NTH / CDAY E / YEAR TED I TIME ❑ AM COLLECTEDPM COUNTY NAME TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: Q PUBLIC ❑ INDIVIDUAL I.D. N0. CIRCALE GB UP (serves only 1 residence) - NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. DAY( ) EVENING ( ) SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE' ❑ GROUND WATER UNDER SURFACE INFLUENCE ❑ SURFACE L= ] WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) TYPE OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: Total Free) DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date ❑ RAW SOURCE WATER Source # F m ❑ Total Coliform NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑ SATISFACTORY, Coliforms absent REPEAT ❑ E. Coli present ❑ E. Coll absent SAMPLES REQUIRED ❑ Fecal t Fecal absentecapresent ❑ OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml E. COLI /100 ML FECAL COLIFORM /100 ml PLATE COUNT /ml ANOTHER SEC; to SAMPLE NOT TESTED BECAUSE: R TEST UNSUITABLE BECAUSE: ❑ Sample too old growth JUL2(�LConfluent ❑ Wrong container U2 Z TNTC ❑ Incomplete form CITY OF RERroNcl culture ❑ UTILITY SYSUK,$ess debris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY DATE REPORTED LABORATORY: t� REMARKS DOH 305 002 (REV. 4/92) WATER, SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED I TIME COLLECTED I COUNTY NAME MONTH . DAY ,YEAR ❑ AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: ❑ PUBLIC ❑ INDIVIDUAL LD. N0. CIRCALE GB UP (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. DAY ( ) SAMPLE COLLECTED BY: (Name) EVENING ( ) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE "GROUNDWATER UNDER SURFACE INFLUENCE ❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) WASHINGTON TYPE OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: Total _ Free) DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date ❑ RAW SOURCE WATER Source # ❑ m NEW CONSTRUCTION or REPAIRS ❑ OTHER (Specify) REMARKS: ❑ Total Coliform ❑ Fecal Coliform (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑ SATISFACTORY, REPEAT ❑ E. Coli present ❑ E. Colt absent Coliforms absent SAMPLES ❑ Fecal present ❑ Fecal absent REQUIRED OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml E. COLI /100 ML FECAL COLIFORM /100 ml PLATE COUNT /ml ANOTHER SAMPLE REQUIRE11D'' RE SAMPLE NOT TESTED BECAUSE: IAIDBLE BECAUSE: ❑ Sample too old Confluent growth JUL � ❑ Wrong container 0K ❑ Incomplete form Turbid culture CITY OF INIQUebris ❑ UTILITY TEMS SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY DATE REPORTED LABORATORY: ' REMARKS DOH 305 002 (REV. 4/92) VVAFER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480, TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle. WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED I TIME COLLECTED COUNTY NAME MONTH , DAY ,YEAR ❑ AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM. COMPLETE: ❑ PUBLIC CIRCLE GROUP ❑ INDIVIDUAL I.D. No71 . A B (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. DAY ( ) SAMPLE COLLECTED BY: (Name) EVENING ( ) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE "GROUNDWATER UNDER SURFACE INFLUENCE ❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) TYPE OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: Total Free) DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date / ❑ RAW SOURCE WATER Source # 7 m ❑ Total Coliform ❑ NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑ SATISFACTORY, REPEAT ❑ E. Coli present ❑ E. Coli absent Coliforms absent SAMPLES REQUIRED Fecal present Fecal absent ❑ OTHER LABORATORY RESULTS TOTAL COLIFORM /10 ECEIV� /100 MILFECAL COLIFORM m /10 PLATE COUNT /ml ANOTIJUffy?00004RED SAMPLE NOT TESTED BECAUSbITY OF RENTM-NJNSUITABLE BECAUSE: ❑ Sample too old !UTILITY SYS 1 cNP Confluent growth ❑ Wrong container ❑ TNTC ❑ Incomplete form ❑ Turbid culture ❑ ❑ Excess debris SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB NO. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY 11 r DATE REPORTED LABORATORY. REMARKS \. DOH 305 002 (REV- 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted_ Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample. the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE_ Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. I MODATE NTH / GDAY E /ED YEAR I TIME COLLECTED COUNTY NAME AM PM TYPE OF SYSTEM IF PUBLIC SYSTEM. COMPLETE: ❑ PUBLIC CIRCLE GROUP ❑ INDIVIDUAL I.D. No. q g (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED I TELEPHONE NO. DAY( 1 SAMPLE COLLECTED BY: (Name) EVENING ( ) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE U GROUND WATER UNDER SURFACE INFLUENCE ❑ SURFACE ❑ WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name, Address and Zip Code) TYPE OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: Total _Free) DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other ❑ REPEAT SAMPLE Previous coliform presence Lab # Date / / ❑ RAW SOURCE WATER Source # Fs] ❑ ❑ Total Coliform ❑ NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑ SATISFACTORY, Coliforms absent REPEAT ❑ E. Coll present ❑ E. Coll absent SAMPLES REQUIRED ❑ Fecal present ❑ Fecal absent OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml E. COLI /100 ML FECAL COLIFORM /100 ml PLATE COUNT /ml ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTED BECAUSRECEIVNSUITABLE BECAUSE: ❑ Sample too old ❑ Confluent growth ❑ Wrong container JUL 2 2 200 TNTC ❑ Incomplete form Turbid culture ❑ CITY OF REN-MNKcess debris ^Vc — c SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAB 110. (7 DIGITS) DATE, TIME RECEIVED RECEIVED BY bil os3iq DATE REPORTED LABORATORY: REMARKS DOH 305 002 (REV 4/92) \'&ATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAC 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE_: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office. Laucks Testing Laboratories, Inc. 940 S. Harney Seattle, WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed, sample will be rejected. DATE COLLECTED TIME COLLECTED COUNTY NAME MONTH DAY YEAR AM ❑ PM TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE: PUBLIC ❑ INDIVIDUAL LD. N0. CIRCALE GROUP (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. _ = DAY(: ) f, EVENING ) SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.: (Name) SOURCE TYPE E GROUND WATER UNDER SURFACE INFLUENCE SURFACE []WELL or ❑ SPRING ❑ PURCHASED or ❑ COMBINATION WELL FIELD INTERTIE or OTHER SEND REPORT TO: (Print Full Name; Address'and Zip Code) 'E OF SAMPLE (check only one in this column) ❑ ROUTINE ❑ Chlorinated (Residual: DRINKING WATER check treatment ❑ Filtered ❑ Untreated or Other_ ❑ REPEAT SAMPLE Previous coliform presence Lab # Date Totak,r Free) ❑ RAW SOURCE WATER Source # a m ❑ Total Coliform Q NEW CONSTRUCTION or REPAIRS ❑ Fecal Coliform ❑ OTHER (Specify) REMARKS: (LAB USE ONLY) DRINKING WATER RESULTS ❑ UNSATISFACTORY, Coliforms present ❑ SATISFACTORY, Coliforms absent REPEAT ❑ E. Coli present ❑ E. Coli absent SAMPLES E] Fecal Fecal absent Fecal present ❑ REQUIRED OTHER LABORATORY RESULTS TOTAL COLIFORM _ /100 ml E. COLI /100 ML FECAL COLIFORM /100 ml PLATE COUNT /ml ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE: ❑ Sample too old ®����luent growth ❑ Wrong container CLCL���r C ❑ Incomplete form rbid culture ❑ JUL 2 cess debris SEE REVERSE SIDE OF GREEN C '(i CQ)1I! MYJ14 OF RESULTS LAB NO. (7 DIGITS) DATE, A& hLbi4tb- RECEIVED BY DATE REPORTED LABORATORY: REMARKS DOH 305 002 (REV. 4/92) WATER SUPPLIER COPY INTERPRETATION OF RESULTS FOR DRINKING WATER The analysis performed on this drinking water sample is an examina- tion for the presence of coliform organisms in the water and indicates the bacteriological quality of the sample. The presence of coliform organisms is used by health organizations worldwide as an indicator for the possible presence of other disease causing organisms. REPORTING OF RESULTS: Group A Public Water Systems must report the results of Drinking Water Analysis to the State as specified in WAC 246-290-480. SATISFACTORY RESULTS: The absence of coliforms from any sample is satisfactory. Proper system maintenance and bacteriological monitoring should be con- tinued routinely to insure the safety of the water supply. UNSATISFACTORY RESULTS: Any coliform presence is unsatisfactory. The presence of coliforms indicates the system is not properly protected against contamination and may be unsafe for human con- sumption. Unsatisfactory samples should be investigated IMMEDI- ATELY and repeat samples submitted. Contact your local health department or DOH Regional Office for assistance in determining the source of contamination and corrective procedures. When fecal coliforms or E.coli are reported present in a sample, the IMMEDIATE ACTION REQUIRED by a Public System is: 1. Investigate to determine the cause and correct the situation. Your local health department or DOH Regional Office can assist you. 2. Submit repeat samples as specified in WAG 246-290-480. 3. Publicly notify the users of the public water systems as specified in WAC 246-290-480. 4. Contact your local health department or DOH Regional Office as specified in WAC 246-290-480. TEST UNSUITABLE: Resample Immediately "Confluent Growth" means bacteria have grown into a continuous mass which makes counting impossible. "TNTC" means bacteria are too numerous to count. "Excess Debris" means that particulates in the water interfere with the interpretation of test results. "Turbid Culture" means an overgrowth of other bacteria can interfere with coliform analysis. If any box indicating an unsuitable test is checked, the presence of coliform bacteria could not be determined and a new sample must be obtained for testing. RESAMPLE: Sample too old. (Sample to be tested must be received within 30 hours). Not in proper container. (Bottle to be used for testing must be purchased from a certified lab within 6 months.) Insufficient volume. (Sample must be at least 100 ml) If not tested, a new sample must be submitted for analysis. FOR ADDITIONAL INFORMATION: Contact your local health department OR the laboratory where this sample was tested OR the Department of Health, Drinking Water Program Regional Office.