HomeMy WebLinkAboutWTR2700860 N.E. 10th" ST. Sunset to Edmonds 6" W-860
Watermain R,,-placement
BEGINNING
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FILE TITLE
51AASC
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QQST DATA AND INVENTORY
FOR UTILITIES - CITY PROJECTS
,ao�4` 38�52
City Project Numbers: W-
S-
Name of Project
As required for year end statistical data for annual reports, the following information is furnished
regarding costs and inventory for utility inprovements installed for the above referenced project.
WATER SYSTEM: b
H
Length Size Type
ADO L.F. OF __�P _" D. Z, WATERMAIN
_ L.F. OF WATERMAIN
L.F. OF WATERMAIN
L.F. OF WATERMAIN ty
" — EACH OF GATE VALVES
EACH OF GATE VALVES 0
T,. EACH OF GATE VALVES 0
9liS C• F. Z" '¢' S T i $
EACH OF 11FIRE HYDRANT ASSEMBLIES $
(COST OF FIRE HYDRANTS MUST BE LISTED SEPARATELY).
TOTAL COST FOR WATER SYSTEM $
SANITARY SEWER SYSTEM:
Length Size Type
L.F. OF SEWER MAIN
L.F. OF SEWER MAIN
L.F. OF SEWER MAIN
EACH OF DIAMETER MANHOLES
TOTAL COST FOR SANITARY SEWER SYSTEM S __
10 0
b
STORM DRAINAGE SYSTEM:
a
H
Length Size Type r
H
L.F. OF STORM LINE H
�— L.F. OF STORM LINE �m
L.F. OF STORM LINE
L.F. OF STORM LINE
- n
TOTAL COST FOR STORM DRAINAGE SYSTEM $ K
ro
x
M
0
H
Submitted By:
Project Engineer
Submittal Date:
•In lieu of listing all utility imp +ements i_utalled, itemized pay estimates or spread sheets may be
attached he,eto if applicable c.. :s and inventory are highlighted and totals are shown above on this form.
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STATE OF WASHINGTON ^ ,
DEPARTMENT OF SOCIAL AND HEA SERVICES, .,. F SOF WASHVJOTON
l ' - � Of WENTT O OF SOCIAL AND HEALTH SERVICES -�
WATER BACTERIOLOGICAL ANALYSIS WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTIONS READ INSTRUCTIONS ON BACK OF GOLDENROD COPY $AMPLE COLLECTION. READ INSTRUCTIONS ON BACK OF GOLDENROD COPY
i It instructions are not followed,sample will be rejected. It instructions are not followed, sample will be rejected.
F TE COLLECTED TIME COLLECTED COUNTY NAME DATE COLLECTED TIME COLLECTED COUNTY NAME
MONTH/ DAY YEAR MONTH DAY YEAR
L - f -
r•, O AM PM
ITYPE OF SYSTEM IF PUBLIC SYSTEM,COMPLETE. yPE OF SYSTEM IF PUBLIC SYSTEM,COMPLETE.
�PUBI IC I,D. No. —T tf CLASS BLIC -1 1 RGIf Cl bs
❑ INDIWDUAL 1 � /, Q 1 z a a I.D. No. Q y A
Lw...�r�,wuwaa i INDIVIDUAL
{ NAME OF SYSTEM OF
BEM
I NAME OF SYSTEM
SPECIFIC LOCATION WHERE SAMPLE COLLE •�•� JAB`
I w uew,W•sloa.I..•won,Igy,l.,1y � ������ � SPECIFIC LOCATION WHERE SAMPLE COLLF[TE SYSTFAI OMlERR/MGR.MAIMEANDTIELEPHOMEND
Ir.nrNN,«P•«naa In mlx+I•.Ieulp.Ny
CPg*z V4�ol�. art ( i; w*<<�C act d T'zk =I cy
( ) -
SAMPLE COLLECTED BY:elalaal SAMPLE COLLECTED BY:IName)
C.oN A ycC al'3 \ -)�
r SOURCETYPIE i SOURCE TYPE
I ❑ SURFACE ❑ WELL ❑SPRING ❑PURCHASED ❑ COMBINATION 111 : COMBINATION
or OTHER ❑SURFACE ❑WELL SPRING ❑ PURCHASED a OTHER
SEND O:IPrin1 Fu11 Name.Aeereu ane A ri
.fi j SEND REPO F¢ O:IP,r}mI Fun Nama.Aaerese anG ZIp 1
J T (C
E WASHINGTON ti"` \G. �I'll. ,\ 1 WASHINGTOM
TYPE OF SAAWLE TYPE Of SAMPLE
j Vd - wRY.w in Iry.cwwnry
i j Is. Wf—MI•„s
— cw.,nn,
1. ❑ DRINKING WATER ❑ Cnlonnaled JResrdual: Total L ❑ DRINKING WATER
_Free) , ❑ Chtorinateo(Reslduot:-_Totol_Froel
I
check treatment--P, ❑ Filtered check treatment—) ❑ Filtered
❑ Untreated M Other___ IIII--------��t1 ❑ Untreated or Other
2 RAW SOURCE WATER I I 2_ y RAW SOURCE WATER
3 NEW CONSTRUCTION or REPAIRS f 3�lFLCTNEW CONSTRUCTION or REPAIRS
4. OTHER(Specify) I 4, J'OTHER(Specify)
COMPLETE IF THIS SAMPLE IS A CHECK SAMPLE I I COMPLETE IF THIS SAMPLE IS A CHECK SAMPLE
PREVIOUS LAB NO I F PREVIOUS LAB NO
i PREVIOUS SAMPLE COL LE,.TION DATE _ PREVIOUS SAMPLE COLLECTION DATE
REMAR S:
r { REMARKS:
t
LABORATOIY RESULTS(FOR LAe USE ONLY! I
LABORATORY RESULTS(FOR LAe USE ONLY)
COLIFORM I STD FATE COUNT SAMPLE NOT TESTED MPN•COUFORM STD PLATE COUNT SAMPLE NOT TESTED
BECAUSE: BECAUSE:
S aw.R,un.. �_ �nn SIww P.«Inn �ml
r1' MPN DILUTION TEST UNSUITABLE ❑ Sample Too Old MPN OILLMON TEST UNSUITABLE ❑ Sample Too Old
---/100 011 1. ❑ Conflw•nl Growth I O Not I,.Proper Container ADD lnl 1. ❑ Conl luenl Growth ❑ Not 1n Prober Container
MF COLIFORM F-� MF Col 1rORM
2. 11 TNTC -X- Insufficient Information 2, ❑ ❑
TNTC Insulllcient Info-mabon
/IW ml Provided—Please Read ) /tW nR Provided—Please Read
3. ❑ Excess Debris FECAL COLIFOR
i Instructions on Fom 3. El Eacess Debns Instructions on Form
`
r M k
FECAL C.OUFOq
❑ MPN ❑ MF 4, ❑ ❑ ❑ MPN ❑ MF 4. ❑ ❑
k /1 W all 100 ml -
I( FOR O NKING WATER SAMPLES ONLY,THESE RESULTS ARE: FOR O KING WATER SAMPLES ONLY,THESE RESULTS ARE:
{ .SATISFACTORY ❑ UNSATISFACTORY � SATISFACTORY ❑ UNSATISFACTORY
I SE REVERSE SIDE OF GREEN COPY FOR EKPLANP TION OF RESULTS SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS
L.AO N04 OA E, ME R CEIVEO- RECEIV D BY LAB NO
NFAT-,ME DEIVEO.-
ojc) r
DATE REPORTED YV.
DATE PEPORTEO , LABORATORY: 9
REMARKS A(•/`t ,��.y // ^ I REMARKS I
WATL.A SUPPLIER COPY ®, j i WATER SUPPLIER COPY
E 1
NE tor" Si. -C if sww5tt.
DATE 7/10/86 C I T Y OF RENTON P.0 Na
RE UISITION —38§42
DEPT. Water Main PnanrP
ACCT. 491/0no/i5/SQr '1A 65 15 $ VENDOR NO.
ACCT. $ PHONE NO.
VENDOR NAME AND ADDRESS VENDOR "REMITTAMCE" ADDRESS
Y. DESCRIPTION IN DETAIL AMOUNT
LEI
1�J PURCNASING TO ORDER AUTH. BY: 1 4a✓L�. C��i
Je,�
ENDING
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