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HomeMy WebLinkAboutWTR2702807 WTR-27-2807 1 rA _� BEGINNING OF FILE dpw 40M WATER PROJECTS SW ITH PLACE SHORT PIAI j . r Loucks Tooting Laboratories,Inc. 940 S.Hamev Seattle,WA 9810P WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION-READ INSTALIC11ONS ON BACK OF GOLDENROD COPY N Instructions mm Mt 10%wed,arlRlple will be elected. DATE COLLECTED TIME COLLECTEM D COUNTY NAME MUNM DAY Yf AR �_ _ _3 • TVPF OF SYSTEM IF P.'❑AM GP SYBTEM.COMPLETE; �XPUBLIC 1�L� v ❑ LL INDMDW I.Q N0. 1 5 C!A GROUP IRiwEanr 1 neLnoY ) NAME OF SYSTEM W 47- ZFa7 CITY SPECIFIC LOCJQIONWIS?RE SIMPLE COII[C1I� TELFPFS)NE NO. W. 4YA DAY "7 EYENINOI ) COLLECTED BY P'tMDM SYSTEM OWNERM1pR. NsmN f U L C E SOWCE TYPE GROUNDA PLUNDER SURF NFI.UENCE ❑SURPiK;E ❑WELL a El SPRING ClPURCNASED w9(C�'QPF INTERTIE >WNlR�tA TqN SFE�lt WELL FIELD f REPORT TO:MIDI Fuz N—.Atla,erM Zp Co W Y4 r �G (_' 1 1 TTI T4 F I C TYPE OF SAMPLEIqvCk a,n,orle M MIS column) ❑Ip1INKR/G WATER ❑Chi ry w IResltlwl. CIwk tWtment ❑F,ft~ ❑IMRYfed ar O"w REPEAT SAMPLE PIFhgUE Co111ppI PIMMae LM• __ Dote ❑RAW SOURCE WATER Sounv P a DOEIOrrll NEW CONSTRUCTION a REPAIRS T"C0"Mm OTHFR IS.ow REMARKS (LAB USE ONLY)DRNKNO WATM RSSLKTS ❑UNSATISFACTORY.COkbrme Pn t []SATISFACTORY REPEAT ❑E Cok PreAent ❑E.COP Absent Cd Ab"M 1j 8AMPLEB REQUIRED ❑F.pnMnt ❑Few ilt,&K O111SIt LABORATORY Asaa S TOTAL COLIFORM /100 m1 E COLT _ _ , ML FECAL COLIFORM _1100 ml TV COUNT /ml ANOI EFI SAMPLE NOT TESTED BECAUSE t'TFRR [q ''�►��UNBURABLF BECAUSE: 1 ❑SAmPle too Old / CoDlluAnt ummh ❑W"V o Ramer CITYg TNTC ❑IncomPWe k>.D, "TIL11Y�V culture e ❑ _ Esaw L" PY FOf1 FZ Pt AHAI ION lif It W ND O plDlrs, Mtt.nME eFCFMO RTCENlD By I TE tAB0MTOIR' •�� t . T r �rEw Ar WATER SUPPLIER COPY Laucks Testing Laboratories, Inc. 940 S.Harney Seattle.WA 9B10B WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:REAP NISTRUCTIONS ON BACK OF GOLJENROO COPY R InatrtA:Gorte are mt tollcweG,eanwis wW be relected. DATE COLLECTED T COLLECTED I COUNTY NAME [)AM 14PM TYPE OF SYSTEM ■PUBLIC SYSTEM•COMPLETE. �FUBLIC ❑INDMM1Al �� DIVA V \Oa lIP irn..mq�weasi �1 V 1..+ L. \J 1 NAME OF SYSTEM r I 7- �f�7 t i L 3PHSFIC IOGT10N WHERE SAMPLE COLLECTED TELEPHONE t10. 4-T.1 k"- DAY S * F(C L EVENING SAMPLE COLLECTED Or,..iNernel SYSTEM OWNEMAGR..INrr1I ! SOURCE TYPE u GROUND AT"R UnDEP$ INFLUENCE ❑SURFACE ❑WELL w ❑SPRING ❑PURCHASED w COMBINATION _ WELL FIELD rNTE" wOTHER SEND REPORT TO:PNen Fw Neme,AMreea III ap OPMI TYPE OF SAMPLE(,heck wth Pru M ft. 1400TIN � WATER Ll NKIE DRI Chl0fr taE(Reedual: Raw ll ck tmtmant ❑F,K~ j ❑Uni Y1M M O nh ❑REPEAT SAMPLE - Pnvgw<dlhMm � IVeearca Labe Data ❑RAW SOURCE WATER 9Lwrt:a e ES m ❑loth CPobnn NE W CONSTRUCTION w gEPARi$ ❑Fapy LJ OTHER ISPwM REMARKS' _ C F (LAB USE ONIY)DRINKING WATER RESUUa ❑UNSATISFACTORY.l:aatorrne peeent ❑CSA cblwraejSeaE REPEAT ❑E.CeT vow" ❑E.Cob a0eeht ❑FecM PleeeVlt ❑Fe(MI eMMI OTTNBT LABONATOW RSI llT'a TOTAL COLIFORM tj /100 ml E COLI /100ML FECAL COLIFORM /T00M ae...PLATE COUNT —_— ANOTHE'IwP[F�Yi.. SAMPLE NUT IESTED BECAUSE ��E���tL�eV )��aY�Ei. ❑Sample Iw da r'FAIt ? / EgYAh ❑WMN cpMeu,er TNTC ❑MCOmplete tent CUTQm SR9 t:tFNr. SEE REVERSE SIDE OF GREEN COPY FORE..ANATTON a ttt t;.. W ND p OltaTO OMa•taAL MICEIVeO ALOE r j � I�rlrela"Ill WATER SUPPLIER COPY r I Loucks Testing Laboratories,Inc. 940 S Harney Seame,WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSI RULTIONS ON BACK OF GOI DENROD COPY R MFIBYI1paBFM N Ilpl wRww,p�R0 WN aB wispws. t DATE COLLECTED THEOOLLECTED CDU(ry NAME—� Mi1M wr rpM TYPE OF SYSTEM IF N1al1O SySTEA,COMPLETE: PUBLIC �ITI�II--�11 ❑INDIVIDUAL I_D.%. � EOBn01w , P+A+.wrlr.ppYleA1 Mille of SV TF M EPEGFIC LDEAIOIFWFERE SMsUODUECRD TELMN@MNO. — -DAY i _! SAMPLE COLLECTED ar;(IYIpp) BYSIW CrFNEilAA011.;(IIalAA) 901/RC£TYPE--T�—OROUND MMTEIF WFll1ENCE❑ µ' -- SURFE �WELL FIELD ❑ePR"16 ❑�" ❑ TaN 8ENO11 EP6 4 7 ((FINwMlFlpp,Agar pM 2a Dwp1 pllYlrpllpN rvPE OF SAMPLE IdrFLk wM aIy In ply AAAAA11) 1 DRINKING (R@. RINRINOWATER ❑ RAW_FIN) CnICkYNbrrFM —..--�❑FIEYW MpYM M U ❑I woow REPEAT SAMPLE -- FYprylw ooYbrm F LA 0 RAW SOURCE WATE R SOIpq A I g T TOW Cn NEW CONSTRUCTION m REPQ,FIS 1.1J F�CQW� OTHER(SMdM) RWAMq: It"USF ONLY)DRINKING WATER REsun'. ❑LOGAUVACTORY,CoawmmFIIFOFIE 0 SSAAn�.CowMSmC=. T L]E.call E.CIA p00NN ElFpwl PlaaOlp [�FglpllFplp " i OIMIER LAa0RAl01M Rp11Lle I TOMOCLMORM MOD ecou Anmy I REM WLKORM,—n001M PLATE 000NT A/gTNER SAMPLE REOUgEO - ... ' SAMPLE NOT TESTED BECAUSE TEST UNSUIIABI F BECAUSE Smwow w m 11 OCIIEIMi 7a•� • C plBolloMr a� TMOM pA L" eowsaMR F` SFF HF'W FISIF SIDE Oi OFR IN C0IlY LOFT EAPFANATILrI LV NI S. W NO.0ML DOTS) OATL TIME 1E0EMO wCFNEO pI I M IIEPMIRD....�•_. LApdNTMY AMIINkp WATER Fl pier I WATER SUPPIPL JER C.QP1 All Short Plat (SHPLp___�- ) REQUEST FOR PROJECT N Prelim.Plat (PP/ CAGI ) To: Technical Services Date /o- q - /q 9 WON 68ItGO Green# From Plan Review/Project Manager A C/ L.� 6-< Project Name $, r.V, i /Oe, SNg T A�17 - ee (70 eha m mac) Description of Project: V yf,7-,4' e }IrW ua S(±j OI OX041 A L�,kM►4,N 4ND &7-JA4IVvE dcT_ Circle Size of Waterline: 10" 12" Circle One: New or Extension Circle Size of Sewerline: ® 10" 12" Cucle One: <EDor Extension Circle Size of Stomiline: 15" 18" 24" Circle One: New or Extensio Address or Street Names) 600 9GcJCk (ry F f w, �if�C • Dvlpr/Contractor/Owner/Crisp:: J0 wr N-6ez4-z (70 chendcn nuc) Toll NA,cr Rw0 A UCIATtS Check each discipline involved in Project Ltr Drwg N of sheets per discipline I Trans-Storm ❑ j� 2 SOrc IJ _.T - � (Road+sy/nnunaaq (On sie:vnpromn,um)Qndud•:Ovin nuns) (include TFSCehe<u) ❑ Transportation (Sgrw"5an chwetiudon,l-lahuna) ❑ ❑ Wastewater ❑ a Z SA0.4f-n 3 16 imowy Se.0 Mein(�mlude Ouin ou ) XWater (hlaim,vavu.Hydmu) ❑ (Ineludeeompoliief.H0AWnL' cut Shaul ❑ Suface Water O O Improvements 1 fnaade huln namej TS Use Only ...1-t�" "-y�G-7 - -�e�lj� v\.-j —,,1- 7---� o 7 PLP,- ;17-3-S07 6M .4- — SEE l DRAWING(S) �I WTR-27-2807 .�► BEGINNING OF FILE " 7 _ Wg1�M b1�w62n�nr. . WATER PRWECT FILE TIFFANY PARK ELEMENTARY 1a � • SEE DRAWING(S) Laucks resting 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 JCOUNTY NAML MONTH 0.1 _VEM 1' M_ CO �AM ❑PM klrT " TYPE OF SYSTEM I IF PUBLIC SYSTEM,COMPLETE: ---- r PUBLIC 1NOM CIFiGy.E GROUP ..x AI � 1 •P I Omh� ,apse � 0 l/'_`i1• 9 NAME OF SYSTEM SPECIFK:LOGigN SA\pLEC`OLUCTED TELEPHONE , (I,f f //4rd Its, / hY GAY_( Z I 3Jr- V A VAUk - EVENING // / ! SAMPLE COLLECTED CY.0larlbl SYSTEM OWNER(MOR..INrM) ' n I we rMeAa arz It.4. A 8 SOURCF TYPE GROUND WATER UNDER SURFACE INFLUENNTCI.aE,,,��'�„„,�,'�'� ❑SURFACE ❑wF w ( SPRING []PURCHASED or LA,.,�m,wnnTgN jO VALLLFIELO INTTfRTIE aOTHER SENIj DDRT . aFUM /I/CLC1M A�it le �e ♦ ) lJus �J TYPE OF SAMPLEIpllaok only on,in this rolwnn) []ROUTINE `1 CnlwmelM(Pali" 10.1 1.ee) DRINKING WATER Chock trMtTenl ❑F'rieno ❑UntnatMer011w__ _.. . _. ❑REPEAT SAMPLE Ybvroue edeam praeenct Len e _ Dab ._/_._/_._ ❑RAW S(NIRCE WATER Sou"e m hid cistern, NEW CONSTRUCTION a REPAIRSPass Castor.. OTHER ISPacINI_ __ RE RKS �� .. ...—_. ..ram . _ . R ,i (LAB USE ONLY)OIISSISIe WATO RlS11Lis ❑UNSATISFACTORY Cdlforms present SATISFACTORY. WIFOnns meant REPEAT ❑E.Cab wesrll ❑IE Coed~I SAMPLES REQUMED [IFagl present ❑Faced aesent _ O"MR LAaO11ATOMf MNIUS .— TOTAL COUFORM_I100 ml E,COLT_ n00 MIL FECAL ODUPORM__1100 red PLATE COUNT _ M ANOTHER SAMPLE RENIIRFO • SAMPLE NOT TESTED BECAUSE 'TtSI UNISUITABLE BECAUSE: ❑S•nrle too Wo ❑ConlKrnl I Ilh ❑world contains, ❑TNTC • ❑Incomplom form ❑Tull cNeAs ❑....___,_.__ ❑Ekasa deWle SEE REVERSE SIDE Or GREEN COPY FOR EXPL�ION OF RE YU T LAIS IVO(I DKWM om.mm IIECaNFI) FFCFMD ev F � • >l � v� j a� 7Qc0 I ! '�S i1�u1 . DATE REPORTED tAaDM1 — ATFR SUPPLIER Rr WAl' PLIER COPY 1 Loucks Testing Laborator'OS.Inc. 940 S.Ha"Y Seattle,WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION.READ INSTRUCTIONS ON BACK OF GOLDENRDD COPY N IrAbwodo ew not TotbweY,eeeWe will Be FeleaW. Ii I DATE COLLECTED S o+n cwi 8 av nAB k T, --_ . F PUBLIC SYSTEM,OOMPLETE: C GROUP PE UPPEcSY❑ mnTE LC.ND. / PJ S `N 0-- �rrd,» N"OF t iT7 � Sir FIC /� 8A1llE C0LLECTEO TtiM101E N0.+. — r/et` �p ��-� DAY .— EVEMq �, j, SMIPLE CdlECTED lV:RM,nI SYSTEM OWNERMR,:(Nom) _— � .sitxd 90URGE TYPE GROUND HATER UDERSNMLIAn/CE ❑SURFACE ❑WWELLHEIyR�❑SPRING np EVEEDa ®w WION • f OTHER sE�I+�orc�O(I'm Pwc /Y Go") — TYPE OF SAMPLE W"Cray ar nor aAaml �...�DDRINI(ING WATER L.I IRe°A'e'. _._RW_Flee) dwk WMWret - FA [J REPEAT SAMPLE 1 P, mEtan,p r Lb a _ t i (1 PAW SOURCE WATER 8o W® m ThW owkm ILKJS NEW CONSTRUCTION a REPAIRS Few Come OTHER(Spaft ' - -iw DBc aNLn awRwG WATERRpwn fj UIDATISFACTORV,cawmr PWaaM ❑ A!TIWVU7 RQEAT ❑E.Cog Pwr,A ;:l E.Cd a ml Q�r1m11lelee R ❑FWm PWawK U Fear lTleRlt - onKa u_wiuiG�rNNaA TOTXOOLIFORM_11 AQDAW LOW norm -- PIDnCOUPORM_nODmIFunCOUNT AN ANOTHER ANOTHER SAMPLE REOURED SAIWLE NOT TESTED SE(:AUSE: TEST UNSUITABLE BECAUSE: a 80*9loam n owmAKpowR [.�wwo oomYRl [ TMTC Earn aaaNa SEE REVtI1SF SKTE OF GREEN(X)PY F(Yi t'KPUtU1KM!IN 11 tmw ItaGRWI WTI.TWA WMARD „Lurv[oxv w,e RF rtr,Ilr w�u-oolwWr♦ .. w . r.uPPLIEFI MpV Lauolu Testing Laboratories,Inc. .. 940 S.Hemey Seattle,WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLF COLLECTION:REAP MSTR(CTK)NS ON RACIi OF CCX.DENROD COPY a w4wwwnm an am ranow".eem ft WBI be nbeelN. DATE COLLECTED T1yE COLLFC D COIMTY NAME �qR "V reN IZ f L 1 a 00 p Arw AM TYPE OF SYSTEM P PUBLIC EYWT!!A.Do1KLETE: —. PUBLIC qRp; I O C" I,D.NW� / S O 41�e OUP waif d 9YSiEM �J ---- I � `� SPECIAC LOCATgNV11El—TE BMRE OOLLECIED illIP110N!ND. __. _ ✓~[ t" A u.l D 1! I DAY SAMPLE OOLLECTEO WY:OMIT 1 SYSTEM f1MMFRAIOR (NAnwl- _ SOURCE TYPE GROLM WWTER —SURFACE INFO UFNCE L]9UREACE �i> ,. ,, Bp p Mp TPHTI 3kUa SIC(TH RT10N 9END� ILL F—IE-bDINL`--_Adftr��Q�) ._.'_.L __— /O SS" Ba, a n�I A.µ�/ygp� r 1 ICA& YYyrIW /C+V.� ,i TYPE OF SAABREpd Ply Vla h BYy uuAetnl _l ROUT"N OFIIWWGWATFR CIIwWIMrtI PIMeMrt_„WIY_pee) ANAL oennen -----. POW" REPEAT SAMPLE .. Plwqm Caleorin p� LW e Den / y RAW SOURCE WATER 9oww 1® � I�i TOW Caft m NEW CONSTRUCTION a REPAIRS PL�15 P40 Claims OTHER(Sp ) I [�UEIM"ACTORY,Callon peso �"� REPEAT (�'�{E.Cerenwm F E.OeEYwN {i fa!OUM® LJ�fwrM H1,0066E 1 own LAIEoumm fmxvs t *oTA<oaPo11M nooTw E.Am_L.40" OOLPo1W1 ANOTHER SAMPLE PLAU Ep — AM IMMI E fWTISTED BECAUSE TWOTUNSU17ABLE BECAUSE. 1t []f1snow wo aM Cw^m,t 9n`ATA iJ ',�I MIMOnPww I Tw w*A" Lf j j EmuftaN WE REVERSE $NIk Uf ORI'.EN COPY f O11 E%PI ANAOON EN Rf:,i I LyNaoomm AEC{IY[D Atamoe. 4 EATS AErCRTEB LAWOIM t WYl1a � T eeMrwAevw WATER SUPPI+ER COPY ShortPlat(SHP a_�_ ) REQUEST FOR PROJECT N Prelim Plat (PPA�_ ) ^^ CAG p c To: Technical Services Date I° 0uW0N From: Plan Review'/Project Manager i Project Name I 'tA4"'L']/ / GA — -t���f/��o+J�•i�,y — 1+ F (lodww ) Description of Project: r Circle Size of Waterline: 8" !0" 12" Circle One: Ne or Extension Circle Size of Sewerline: 8" 10" 12" Circle One: New or Extension Circle Size of Stormline: 12" I S" 1g" 24" Circle One: New or Extension Address or Street Names) I tool Dvlpr/Contactor/Owner/Cnslu: tj 7�'Z G po wn,< A\ ac.� 1 Sze ,E Check each discioline involved in Project Ltr Drwg p of sheets per discipline ./ J O Trans-Storm ❑ O (dead-arlt)(%im e) (Off 14 tmpmvC.uxlndude basin nasrc) -- (in<lud<TPSCrMeul ❑ Transportation (SigW=u anChsnAu.uan,uandnal O ❑ p Wastewater - / Sw;uey Sc..,),J<in(ImIude basin namy GY \Pater (wr.v.v61.as.xra, ut T Z (In 0 Sh<eu) Id Suface\later 1i1 ❑ } �� "` we lmprov,ments incrude bun name) TF Us, Only W� R' r�7-�gytJ \N WWP 845 S �byg tut tidnll�, l SvV P ate- D%H �..'14?�t4 h -)•tom`may. ' •�, ��, -� -� .- ;�C,t..�:. _ .ylc � , ,sir( � NOV-06-2000 MON 12:21 PM KING 00 FAX NO. 2968431 P. 03 L.auck•Testing Laboratories,Inc. 9�,S Hf�ney SPAPk.WA 9E'08 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTORS ON BACK OF GOLDENROD COPY r It ingmcbont Ara not followed,ample will be foliated. Ders cOu.scTED I I COUP O c' UFtTV NAMI YONM wv viM1 11 ;�_ ❑PM KENO rips of EYET N iP PUGLIC 4VITIR A.COMPLITE: Q• _ Qf Pwuc CIRCLE Go" ADUAL NDAI OF EYST•A SFSOInc LOCAnO, AMw ECOLu�LL'TIO TII> by zit 2G ye A AV1 +• FANING I SAMPLE COUACTIO EY INrnU SYSTEM OWNtnmw•INNneI 1vI I,LerAPhEBI.-e- • _ : SOUACEriM *KOVNO WATER UNOER SURFACI INFLUENCE C AUAFAtt❑WELL or IRO QpURy`wAifOw /10N WELLPIELD MT 1LT1! ar0 v SW }p�pnM Pull N •a and 21p Cony /I /I/GL 7sJ OfSCD �.y • .. �yf riK Oe YMpI{IA,aaY awF aIw in MN cwumnl I•', DM KOWO V/ATiP CnIC.,neN0lReuaua:_..TpU -_Feel imeet tnaemam 2P+N•.a _ ❑Unn41w1 a.UMN_• C REpAAT SNAPLE • - , � PrNeK ea Iwn,C'e+e^p lOb e Dam • RAW SOURCE WATER Saeme I�$ m [�Tplot 0106" NEW Col.STAUC TION ar REPMAS o Palo CNMan illUUUUU��SSS OMP1IPwM_�_ _ 1W VIA 0_Ml'Iboom M WATM RlNllri '."a.,�• ' i C UNIATIPACTORr,owdv.,P,"At .,, T'StACTOon. slNe w,e Ntum • `••�•` e♦ I REpKfAT �LCeu praeMl � Ce'•eapnt �\ e0U1A0 PKM Imom Rots eb�q 01N9111 WOMTOM Ai1ULri TOTAL COUFOAM 1100 n, I COU--n 00 ML FECAL COLIFOAM 1,00 n1 PyA?t COJNT /n`I ANOTNIA IAMPLL,IEOUIRIO SAatPUNOTTESTSOafCAUN. •TEST UNIUITAILI NCAUSS. e G AanDM IN So CanaWnl/royM WrInE ConelNr TNTC "*"**to yrn Tyree C+IWN [][IKeet do"s SellW W C'-1T§ COPY B N T DP rUlC tiNfACCNIKO RPLYMh Iv "S""dawmo I woRero I I1{1YtR I aM YR�11(Y M 1 � 1 AenD eYnnV nnny SF-11-200C MCN 09 21 4M F;X NO. I Laucks Tasting Laboratories,Inc. Laucks Tasting Laboratories,Inc. 940 S.NVnaY SPAT.M.WA WIOS (^` 940 S.NarneV Soaroe WA 98106 WATER BACTERIOLOGICAL ANALYSIS I WATER BACTERIOLOGICAL ANALYSIS SAMPLE COUFCTIOFf READ INSTRIUCT[)NSON BACK OF01MRCDCOPY SAMPLE COLLECTION READ INSTRUCTIONS ONBAIXOFGOLDENRODCOPY R In.wr tl*"an mil/afaWal.MTpr will DD NtIAM. I At In.wolbn.am RM rMle«aa.sompo"u be NiapAM. CATS COLLE eD T1Me CX LICTED cOUNtt IIAMF DATEGOUECTEO TO GOLIAeCTEO COUrArNAM aMM'N ar TE41 IL j „DxIN PAY YW rl Ll -I rnEOf SYSTEM I Ip NKIC SYSTW comil 'wl OF SYSTEM tF NMIC SYSTEM.�0041 vLETE- —� QPull C CIRg�ORW► �NSLIC CPOLE GROUP 1� aW MDUAL l I,D.ND. QI Q (� (V a C Mil I.D.ND, 0 L © B NAM!OF SYSTEM $wf L WAE COLLE " LPN NO. (�1 y`IC\f [AMr1[COLIECTED�TEIE !NO 1'lar 41b 1 Owl 11 /'i2Cy l.'/l )Sl °a" 'tyINING 1 1 `` WENMO 1 I MK ECTEO IV,:(NiMp I SYSTEMDWa1ISMAOR:MUM) _v\+ SAMPLE COI ICTID[Y (NOMa) SYsrEMOWNERMGR (hwo 3OUNar" Ll GROUND YMtER UNDER1�S,URFAC[IN/LUNGE sOURCf 1YPE GROUND WaT4l UMMRSURPAC NRUENC! SURFACE WELL« �sIRINU uFURC)1ASPO« �'y�pa�WAnON I�SURRLCE Cj WEILa ❑s.RING CpURC"It '�,cowWATIoN WELL/IlID N.'BRT! �'4 C'N111 W[LL FlRL fITeRTIE sOTNER ENO ROO TT I�NA •�NYna ADAMY«M AP ) SENDA P T 1 Am ul AaIMY aM 2eCWI�G sr � _��.�� __ TYPE OF SAMPL[IgMA aTEran N1NP ZAAIW) TYPEOFSAMPLE~&W& MAAReDa/RM LJ RfA1TtNe �,�CAbmNbe(%".l-_TDW.,.FNa) rU ROUTINE � CJlb,wala0(Raeauv-_.TPW PMA) d11NR WATER rL�-I 011 WATER OI«a"411 I --..... FlaamA NRa Ma=1 pyM Guna+abf«Ow _ tANRaM«Ova, _ REPEAT SAMPLE REPEAT SAMPLE N«Wa OWN"pNaaw JP 1_ hMYI WRrM P,aaA'Na lAD/ Dab �- f I Dow I I MW SURACE WAYEA Ssfrf A a T ❑TI W OMI«m �1 AAW SO.IRCE WATER Sam I❑ � TAW DIMenF NEW CONSTRUCTION&REPAAS S L Ll ❑Papal Cohn NEW CONSTAUC'*h v REpNAS S 8 a"COM"", OTNtR ISpwhl T//yy�� Ll O UfsowrYl M1Aa USE DKYt aaEeaas wATa MaLMTf M1Aa uaE 0"RMIIORa wool at %" _ �UMSAMFACTp1Y.camarMa MINI SAT�SPACTORY ❑UNSATISFACTORY,C~6~4 C 3ATWACTORR aaaARt NapM aaMN SAAIPLEE []E Ora IIaAIPI 4 Cal a1Mn1 AM LI �E Coil perm 6 CDI ADaM1 p Iw'plwnl ftweam SWEAT MOU1RfO Rf0U1RfO APW MaMI FaaAIY«R OMQ IAIMTOW MSVLTS OTHER LAWWORT AWATS TOTAL COLNORM hDOM S.COU p-mm TOTALCO.1"4 1100w f.cou & AGO., RCN COUPORM.`_AN M RATS COUNT—AIN FECAL COLIROAM_ROD M M'!COUNT__..Ml AIOTNIR Al REWREO AAIOTNER SAMPL[040~ SAMPLE MOT MTED EICAUSE: TESL UNSUITN!.E StCAUSE'. SAVhf NOTTIMO FFCAUSr TEST VNSIPTAKA WAVES' S«RPM NO AM CMRwl on lor $anfb Im DM Lank m[NMI WWI[a«bM, �NTC W,Pry a«'b NI, TNTC Inm,RMab faM1 T 1,44 TAMN I+m•FbM I„n,l TMM1 MANE EEE MTNIIS11 Sint OF GREEN COPY FOR LXK"1O11 OF MSkAnk LE RMASE 9*1 OF(GREEN COPY POO EXO~11001 OF RESULTS W Yp.p&&Ta DAry•ryr RiCA'YED RlCIM0e1 WRO IT M&tN W�a 1.4 YeI•ND REaMNea, 0$1 �-ISSIm 0$1 � 15 13 pRT FpRT{D �wEOMT DA PMT[O' WO I alWela W ra♦Re�w! 1 �WW A....�..�.