HomeMy WebLinkAboutWTR2702857 WTR-27-2857
BEGINNING
OF FILE
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WATER PROJECTS
UNK)H PARK SHORT PLAT _
■
Lsucks Tssting Laboratories,Inc. r
940 S.Harney Seattle,WA 981 D8
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE WLLECTION.READ INSTRUCTIONS ON BACK OF GOLDENROD COW
It instructions are not followed,sample will be rejected,
GATE COLLECTED TIME COLLECTED COUNTY NAM1
MOHI`I MV YEAR 4
rVPE OF SYSTEM IF PUBLIC SYSTEM,COMPLETE:
[�PUBLIC Chi
❑INDhADUAL I.D.NB. 7 1 ts I S 7L A/�)
` J
NAME OF SYSTEM
L 14 ,, '-)}� h %61)4
SPECIFIC LOCATION WHERE SAMPLE CDUFCTFD TELEPHONE to --
r r f DAY - . f ,
EVENINGI I _
E COLLECTED BY INamel SYSTEM OWNER/MOR.:(Nanle)
9WRCE TYPE ,GROUND WATER UNDER SURFA E INFLUENCE
SURFACE 0 SPRING ❑PURCHASED or COMBINATION
❑ WELL FIELD INTEPTIE wOTHER
SEND REPORT TO.(Print Full Mama.Address and Z,,
1
TYPE OF SAMPI ElcNeck wb o m e,N column) r
❑DRIN E U„'.)Hied Malmo:DRINKING WATER Li rael
&'Acl,treatment ❑FEtamc!
❑REPEAT SAMPLE On I orloom=--,— —
Pro--
CWdormpresence LWE_
Dole
0 RAW SOURCE WATER Seises S® m ❑TOW Coalaltn
NEW CONSTRUCTION ar RaMIM CUM"
OTHER lapbeM1. _. a �
dS� " Wr9l
-- (LAB USE y Lr) MORMIKWO WATM RSSIILTS
0~TISFACTOR`•Ueldonre dweare BAT SFADTORY
FEKAT
B ❑E.Cok 9`14-1 ❑E.Coh aware ❑Cohfmm�aownt
1111,0011110 ❑Fecal Present ❑Fecal sossnt
OTHER LUORATORY RSSLILTS
70TAL COUFORM�,./1aB.m1 F.COLI ._/lOp M4
OEM CDLIFORM /10D m1 P" &W Intl
ANOTHER SAka'LF NEOl/N1ED
SAMPLE NOT TESTED BECAUSE TEST UNSUITASL.E RECAUSF
❑Sample too old Cw,Ausnt prowtn
❑W'V oonMamr ❑TNTC
❑atapalpMe awn n Tleeld cYlllum
;UPI I On Lv!n nN,IION r In
LAa NO Qmm DATE.TWT AFCFIYFn RECFrvfll�.
DATE NIsOI/ RW L#AKWA W
� r
WATER SUPPLIER COPY
FER-15-2001 THU 06:08 PM KING CO FA'� NO. 2968431 P. 02
Laueke Testing laboratories,Inc, r 1
940 S.Haney SEatile,WA 9S108
WATER BACTERIOLOGICAL ANALYSIS
SAmPU OLLEC710
READ IN mNSTRUCTT1ON UM O GMOENRRO COPY
11 lala
DATE COLLECTED TIMFyCOLLF�sD CO0 NAME
mow% YEAR
TYPE OF SYSTEM IF PU IC SYSfIK CORNII AA
5eU
LIC
�ieNDMOwI
a &TE Ol L
. NjgwT �fi1G �j IpLFy nYIMiONE N0. -IQ
I �anlOw ✓}�.(.
n ,l � EKv1NG
SNML�COUECTED Sr'.INamel SYSTEMOWNerf UJA. IN EI
SOURCE TYPE GROUNO WATER UNDER SURF ENFLUENCE _
e . . .. .. •E' . ❑SURFACE JKEUL o• ❑SPRING❑OB E ED or Q COMSNERTION
WELL FIELD
EEEEEE►►►AAA
S RT T (P t Fu Nama, an0 41 1�
rY;r Or SAMPLE jchP P,1V Pn•m 1M•column)
�OR NI4NG WATCH C CNeeeal"lRPeleual
T Untn•R6 w Omo—.--
. y �PEPEAT SAMPLE
Pn1,L""Ido'n,wes"ce LIDa- /
Daw
RAW SOURCE WATER S01K0 a ES] m ❑Tad Cov,e,m
[�NEW CONSTRUCTION s REPAIRS C FKr Cdn,'^'
CTHEA ISW,tl0-_—ry
REVAAKS-
ILAE USE ONIYI DRINRIRO WATER RESULTS
VNSATISFActglr.CWlbIma WPunt ❑SATISFACTOW/
CPhFC,m.ORION
REPEAT L C"Pns•nl E Cot anonl
R60V CD Fete a•aent Fncsi absent
OTHER IASORATORY RESULTS
TOTAL COLRORM 1100 m1 E COLI&-/100 ML
FECAL COLIFORM�r100 mI PLATE COUNT "I
ANOTH611 SAMPLE AFOL'AeC
SAMPLE NOT TESTEO EECA1,16i 1 EST ULSuITAELE SECAUSC'
S0104\Po oM LCIMYenI gnl m
~0 rynl.•neI YNTC
*0;pn1 RlP Iwm %nuis'.w.
❑�.__... FaFPr•sad
EIE R[V qF f10 DF DR.EN CO� EXPLANATION OF NIN
W NO OATS "WE AEC1na0 MCXNEO Ev
b`6t 144 3 /
OAR A(rORraO � vRM•.
I
3a1 3 E
I nD rFnITFR COPY
FEB-15-2G91 THU 06:09 ?t1 K:NG CO FAX NO. 2968431 03
Laucka Testing Laboratories, Inc. Laucks Testing Laboratories, Inc.
940 S.Haney Seanle,WA 98108 9e0 S.Hamay SNKIe.WA 98108 ; 1
WATER BACTERIOLOGICAL ANALYSIS WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION:READ INSTRUCTIONS ON BUCK OF GOLDENROD COPY I SAMPLE COLLECTION!READ INSTRUCTIONS ON BACK OF GOLDENROD COPY
If InSUuctlaM am not followed,Semple will be rejected. I It in euONOM am not followed.Semple will be rejected.
DATE COLLECTED TIME COLLECT�,D COUNTv NaME CATE COLLEC-ED TIME LOLL D COUNTv rMME
I'vel Dar raAA �_:�L . MONTH ar vTAA ," 1
Iy I ❑AM ®PM _k/n ��{ LL �l
TYPE OF SYSTEM I IF PUBLIC SYSTEM,COMPLETE: TYPE OF SYMM IF PUBLIC SYSTEM.OOMPLM
CU1CGROUP
�PUS
CJ INDIVIDUALS 7 ' s Q /A\ B ❑INDIVIowI
Ieee"I wIMCN `J a.u.MY1 M,OM.
" Dc YSTIM /1 1 NAME OF SYSTEM
sCrec��%cT�ngy�6 / c�o�aoo4^ ILoex Tqr
/EIW[Yff- Z HE d e f (•PPtBy{�,o��A�__ )NO. 4- /p J3 �:. t�l" a wv PHON grl'l 43
l ;r1, ifAQ/7
1Cr AEI E F�L.L UJI.,l
�Do 3(oLk 4%4 NE ENINCe
SAMPLIFOOLURCT
��0`BY(Name) SY MONMesvia '�/oylal l SAMPLE COLLECTED Ill HAM.) 51-91M OWNEWMGR.'M 1
50URCETYPErEI GPOUNOYMIERWDERSURf EIWLUENCE SOURCETYPIEIqq GRWNDWATSFt1NOERSURFAC INFLUEI1N---ICIE
SURFACE IQ WEL.ar O SPRING ❑PUPCHASFD m COMBINATION r SUkdACE p,Wd L Or E]SPRING O PURCHASED or LI COMBINATION
WELL FIELD WrEATIE Of OTHER . WELL FIELD INTERTIE Or OTHER
SE R rt F Neil Addnot a I Z
,,p Cool SE ]9 vORTTtr Ipml Full NemaJ.d nu WO P C e)
— —
allsru•a. 74.0 .] a ✓N .r.0.n, ��J
TYPE Of SAMPLE ITnvcY enN one In MH c0laev1l PE OF SAMPLE(pNRga OKef PM m Pill.column)
I]POUTINE C Cn!adnelM(MSItlueL-_Tywa_F.ae) [�ROUTNE �Cnmmmd 1IMI _TOle1—.Froel
OIIWKING WATER DRINKING WATER
TAeCK tifOlmi l MOCk lnebmenl I'llerM
ElUnlnelel Cme• __ [ UmraiOfomer----
Ej REPEAT SAMPLE REPEAT SAMPLE
Pmlwd cOlacrm;Mfe a L O A ,Pnr*us correrm penance LAO e
C EIe�_.�_ 1 ' GAP_E__/_..._
RAW SOURCE WATLN SOu¢e A IS m O Tom CalAI I ]RAW SOLRCE WATER Shrde A❑$ S ❑Total Colliaml
Z&NEW CONSTRUCTION or REPAIRS ❑Fecal Collbm I '( ,NEW CONSTRUCTION or REPAIRS ❑Fecal DdOAKm
C OTHER(SPRNN) — I ❑OTHER(so")--_
REMARKS' /LO. (Sso REMARKS/n A O—.`—.- —
Pill
h/ (LAS USE Deal DRINKING WATU RESULTS ILA��j-7B Li B OMLYI DRINKING WATER RESULTS -_
[]UNSATISFACTORY COlilomnt paw Ej SATISfACORV ]UNSATISFACTORY.Celdama Pnun ❑SATIScACTORV
.7� .,me abaerl Odlibrma abaam
REPEAT J.CoE P,aaenl O E.Coe abaent I REPEAT Cl E.Cdv PI �F.COI•weeN
RiOU R 0 L_I FPe:U pKne^1 teeal aNanl ROOV sAlREO (_i FPceI seen Fecal abvenl
OTHER LABORATORY RESULT& ^�OTHER LA-SORATORY RBSUTLS
TOT .AL CowPORM 1100 ml E.COU•_I 00 ML I TOTA.COLIFORM hl/10011 oulkiIOOML
FECAL COLIFOAM MOD ml PLATE COUNT_/mI FECAL COLIFORM_•1100 ml PUTE COUNT•_-"I
ANOTHER SAMPLE REQUIRED ANIL HER SAMPLE REQUIRED
SAMPLE NOT TESTED BECAUSE' TEST UNSU'TABLE BECAUSE SAMPLE NC'TESTED BECAUSE'. TEST UN50ABLE BECAUSE
❑Sample toe old 'F�'COIAWnl pn:wln ( Sample.00 Oe C'l,o lgrov.ln
YL'"J1 Wel OOrmmIfflw TNTC wrong cc Mi., �TNfC
InepmOHlO IOrm "**JJ"SS T.AM4 cvNuri (,Incomp'"O loom n T,Md Cullan
Same,dot. IL�I, _ ❑Emove demo+
i
fifif REVERSE SIDE OF OMEN COPY FOR ERPLMA'"DN OF RESULTS I YER1 SIDE Or OR CH PY wall EXPLANATION OF AESUIJS
Ma NO.POOITOI Ol nW'RECrlvGO AfCFnED_II I ;Ap NO pO.G.m DATE TINE MECIlwo Pf CCVCO BY
OAT[eEPDA ED UMOM DATE Pie D / ,ApeATO
Is 3� 1 -� ; r , -3al - I
nwanrc aPwEEt
ad.w mI AaT...n aRH w en AN w T
- ^- •�^ --•• nil rr.rro ••nOV -
SEE
DRAWING(S) I
7 1 Shdq flat'(SHPL-k�
REQUEST FOR PROTECT 0 Prclim.Plat (PP#
CAG#
U0003si
To: Technical Services Date WON 703 _ Green# GUA�7(
From: Plan Review/Project Manager ui rtY4,,
Project Name �/NI Jnl PQ Q/� S/�02T OLlJ;'
(70 eiunaa:Itti, -
Description of Project: UULg1 1&)V,2Q0CA4L_&7S Rr� (n— SOT SAL�2T leAt
Circle Sire of Waterline: ' L8" 10" 12" Circle One: New or Extension
Circle Size of Sewerline: L/ 10" 12" Circle One: New or Extension
Circle Size of Stormline: l2" 15" 18" 24" Circle One: New or Extension
Address or Street Name(s) _` -F-r /()Q10 0 AL tJ t;
Dvlpr/Contractor/Owner/Cnslu: \nym�) �2ct1� JfZ
(70 charaeten rux)
Check each discipline involved in Project Ltr Drwg R of shee(s per discipline
Trans-Storm y3
(xmdWa)rJnivg;) (Off uu mgmnmenu)(ndudc buin none) (include TESCsheeu)
O Transportation (Sigvliud.k Uu cliudvn,Lighting) ❑ ❑
Wastewater ja J
�.J S.iury S<w•v Alain(rclvdc bin name)
(O Water (A1ai�u,Valru,Hrdrutui �,
/� -- (In[Iud<wmpoum a Hurimnu)Cul Si—
Suface Water Rr 3
Improvements )indvdc buin name)
TS Use Only TE�-`AO-.28577 -1
WWP a - as57 S aS5 T
WTR- a-1- 7 W- a£sS7 r
5WP— a 1 -a857 O 9W7
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