HomeMy WebLinkAboutWTR2700956(1) N. 2nd Sf. (Park to Garden) Water Main W-956
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STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE C01 LLCIIUN HEAU INSIHLIL I IUN':•UN HACK OF GOLOFNROO COPY
If Instructions an not IDllowsd,ssmPls will bs releCled.
DATHDA
TIME COLLECTED COUNTY NAME
MONTHR �Q Il 'Er,L
I' u6uc SYSTEMnEE�o
COM f AM PLETE:R E"Re. --- _
TYPE O 3�0
PUBLIp• No,
❑ IN
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! NAME OF SYSTEM
L nY of ?va�a►+.
SPECIFIC LOCSATION WHERF SAMPLE COLLECTS SYSTEM(WNERINIG" w'ME AMR""WRO
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I SAMP COLLECTED By (Nnml
—A�L. 61061AA (anS� I rsPfc7eti
SOURCE TYPE OMBINATION
❑ SURFACE ❑WELL ❑ SPRING ❑ PURCHASED )Or OTHER
'. SE Q�TEPORT T Tmt Fuu Nema A`�Sa ens 2�Pniwal r r —
�_ 200 M iLL_-- IF SO• —_—
mIrn o WASHINGTON 4ta .
TYKE OF SAMPLE
+" ... ❑ Chlorinated lResidual._.To1e1__Freol
1. ❑ DRINKINGWATER ❑ Filtered
check treatment---Orr-Dl
Untreated or Other
Q, ❑ RAW SOURCE WATER
3. NEW CONSTRUCTION 06R&PAIAS
4. OTHER Ispecll11
COMPLETE LF IS A CHECK SAMPLE
PRE VIBUs IAS NO
PREVIOUS SAMPLE COLLECTION DATE r L
REMARK- l{�•
t / �S___
LABORATORY RESULT FF LAe SE ONLYI
JMSTD PLATE COUNT SAMPLE NOT TESTED
E.
MPN
TEST UNSUITABLE ❑ Semple Too Old
1. ❑ Contwenl Growth ❑ Not In Proper Container
MF 2 ❑ TN EC ❑ Inautllclent Inlormallon
in,twed—sense Reed
i Inatruprovicled— ea Form
FEC3• ❑ Excess Debris❑ A. ❑ ❑l
FOR INKING WATER SAMPLES ONLY,THESE RESVOS ARE'.
SATISFACTORY ❑ UNSATISFACTORY
SEE REV F(.HE FN COPY FOR EXPtJAN ATMN OF RECEIVED BY
LAN 0 DATE.TIME RECEIVED— 7—
DATELABORATORY.
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WATER
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SUPPLIER COPY
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