HomeMy WebLinkAboutWTR2702812 WTR-27-2812
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WATER PROJECTS
CITY NEW SHORT PUT _
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Short Plat'(SFPLN
REQUEST FOR PROJECT A Prelim.Plat (PPN )
CAG N )
To: Technical Services Date 13 L) C/ 9 WON E�)V Z b 3 Greco /
From: Plan Review/Project Ma lager
Project Name (-I.CC
Description of Project: r(j
z _ , w J (�
Circle Size of Wat-rline: 10" 12" Circle One: ew or Extension
Circle Size of Sewerline: ® 10" 12" Circle One: New or Extension
Circle Size of Storndine: 12" 15" 18" 24" Circle One: ew or Extension
Address or Street Names) Y r,. - 4,1i Al4 ) t Al L) Z^ )0�
DvlprIContrac(or/OwnerICnslt:: .q. �
�f (70 ch" n ms.) J
Check each discipline involved in Project Ltr Dnvg N of sheets per discipline
✓ ✓
Trans-Stonn (U/ (/
(aoad.aylDMivae) (Drhio:(mpwemumKndude buin nuns) A (mciude TESC rbeeu)
vl* /
Transportation (Iipuluanan Ounneliueon,Ilabtini) 0V & _
�r WLS(ewater (V iel
Scniury$ewv Mw(include buin none) �/
\Vater (h(uiu,vJvu.Hyan"u) Qr IN
oirl/ (Inolode compodm Q H.H. W Cv1 Slmcu)
(� SufLcf.Water
Improvements )(mclodc buin none)
T6o-4o•a'61 R-�tl�.
TS Use Only TRc-�i -asla — s-as �a
wwP•a'1- asla 5 -a81�
T.R' 20 %(a — LJ -Asia -
SwP-a-7 -agta D-aela
VLA- At A
Loucks Testing Laboratories, nc.
940 S Harney Se WA 98108
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION:READ INSTRUCTIONS ON RACK OF GUt OENROO COPY
N Ntatrwtlona an net fanowed,aaffw*WIN Sa roiaclad.
DATE COLIECTED IT E COLLECTED COUNTY NAME
AgHt1A eAY TEAR 7L_ L?t7
AM ❑PM
OF SYSTEM IF PUBLIC SYSTEM.COMPT.ETE
PUBLIC
INDIVIDUAL I,p,Ns. /�
CM
R�ra.o.M t w.nwnk l.�
NAME OF SYS - —.
SPECIFIC COUECTED TELEPHONE
DAY
EVENING
S'N^. 'OLLEC Y'PMmal SYS1E OWNEPMOR'.INamel--
SOLD TYPE GROUND ATER UNDER E INFLUENCE
❑SURFACE DCI WELL w ❑SPRING ❑PURCHASED w ❑COAIMMYX]N
r—N*EUnL��FFFIELD Atla I�NTTERTIE wOTHER
,.$ 0 RE TOl>fDY�Name.
0
l LY,Lif/.r✓C .rti....
.YPE OF SAMPLE I mock mN one m this columnl
❑ROUTINE CRI WATER O
Ckbmwtwl IR.@KkA Total F,NI
cMck RM k tttmtmen ❑
Tl L�FIRa1a11
❑��"
❑HE PLAT SAMPLE
Praviwta colllwm praaaltq LaD a
Dote }�
o f f.;
❑RAW SOURCE WATER 9ouDa F I S ZY ❑Total CN.toml
NEW CONSTRUCT ION w RE�y Focal Cditam
fI ❑.__ _—_
❑1(OTHER IS�Payo,M}h�� � •17.
.(LAG USE ONLY)ORN KOG WAT'M 1TSSLNTS s
❑UNSATISFACTOi1Y.CRxa Wants--- ❑tMwahnna aq t
REPEAT ❑E.Cob grant ❑E.Co.aDant
REWIRED ❑FOW"Wt ❑hats aown
Most_LANORATOW M&MiS
TOTAL COUVORM too ml'- `E Cal itbo ML
FECAL COLIFORM !100 ml_ PLATE COUNT Iml
ANOTHER SAMPLE REQUIRED
SAMPLE NOT TESTED BECAUSE. TEST UNSUITABLE BECAME:
❑swow too oM ❑Conllwnl iya
❑W"c ttm w ❑TNTC
❑hmRRfa wm Twoq culture
Cl —._. ..._.._. ❑E.can doom t
SEE REVERSt SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS If
W NO P 010)181 UATF.TIME RE(A f b RlCFMEU Sv {�
DATE REFg1tTE0 lAapU
MwM�w.w aYY wl I F
AA I'ER SUPPLIER COPY