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HomeMy WebLinkAboutWTR2702882 WTR-27-2882 BEGINNING OF FILE SOUTHPORT DEVELOPMENT.PHASE • CITY OF RENTON WATER DEPARTMENT Pressure Test fi Purification Test Form PROJECT NO. NAME OF PROJE T SO%AY'`^ ��!'� Y (AI PRESSURE TEST \\TAKEN BY /ie y W1 t,, I ON 21261 Z _ AT A PRESSURE OF PSI, FOR Zn MIN TEST ACCEPTED ON Z 2 (' d Z PURIFICATION TEST TAKEN BY_ h MCA I _ON�/02 / PURIFICATTON TEST RESULTS, SAMPLE M1 A, h Lori SAMPLE M2 SAMPLE N3 REMARKS: F,rA Ace sS iZna,.7 CITY F REN70N WATER DEPARTMENT Pressure Test G Purification Test Form PROJECT NO. NAME OF PROJECT PRESSURE TEST TAKEN BY ON AT A PRESSURE OF PSI, FOR MIN. TEST ACCEPTED ON PURIFICATION TEST TAKEN BY ON PURIFICATION TEST RESULTS, SAMPLE NI SAMPLE M2 SAMPLE Y3 REMARKS: MAR-15-2001 THU 06:05 ?M LNG 00 FAX NO. 2968431 F. 02/03 Faw;Re IOUR19 Laboratories,Inc.I - 040 S.Harney Seams.WA 98108 ^� I (0 , Lmuks Testing Laboratories, Inc. r. WATER BACTERIOLOGICAL ANALYSIS •-- 960 S.HWMV Seanlp,WA 911108 I SAMPLE COLLECTION:DEAD INSTRUCTIONS ON BACK OF GOLDENROD COPY WATER BACTERIOLOGICAL ANALYSIS If Instrugbtn an rapt Nlewed.Sample will be re/eeted. SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY N iRSbpepona eHi mIII fallewed,sample WIN be Hijacked. DATE COLLECTED TIME OLLELTED COUNTY'NAME CA MONnt DAY YEAR , tlJ1 I- GATE COLLECTED TtME_C011 � COUNry NAME 3 I i wµ ❑Pas Ki/1 MONTH /Y of �i/t II TYPE OF SYSTEM IF►UREIC SYSTEM.LOMPLlTE: 11 �PJBLIC TYPE OF SYSTEM IF PUBLIC SYSTEM.COMPLM. 1�1' ❑INONIOUAL 1.0.No. n c CIa�E GROUP PUBL buw onrt+um•rt / a " o I c / A\ 9 ❑INDIVIDUAL 8 S 0 GROUP tiJLD.NN. 7 r c. A o NAME Oi YSTEM �I ^ t�.�n r^a'aa"ral T // NAME (NA� Of SYSTEM lFs T�� NNV,IESM�tFjj•OL/`LEuTED TELEPHONE N v � DAY _ /O�� SFfi4KIC ,Y2 LE M__'m TELEPHONE NO //oo GG�•B. �.rB/1.f la £ono ^(Fy(J� zzt� wr1ZAE,l 444-IP�3 EVENING u S !COLLECTED BV:INamel SYSTEM OWNE R,: om•I IYA EVENING /O /� �/\J /K�•VwI'/ 1 PL LLECET�EeO�BY(Namel SYSTEM OWNEp/MOR.:Ir•IeM) _ SOURCE TYPE OAOUNO WATE /VIA R UNDER SUR CE'NFLUENCE /0'h ,".1 / ❑SURFACE&WELL o, []SPRING ❑PURCHASED a FIOuACE TYPE GROUNO WATER UNDER SURF OE INCWENCE WELL FIELD ❑COMBINATION NTERTIE er OTHER ❑SURFACE (�WOLL or ❑SPNm 3 ❑PURCHASED o.[]COMBINATION B[ppN _-_A:y)nnt ffptNam�Appreaa anpZ p0ey WELL FIELD INTERRI 0,OTHER /•TO/.ww BEyLL TO: riot Fylj Nans.aodw sans 7iP/C'� TYPE SAMPIEleMe4 Arab ens le ens column) NK NG WATFR ❑C�Iprinelep lRe .cu*' _-me _F•w) TY� �'E(Owk poly one N tlde column) nc Elk ee0lm•nt '� ROUTINE •J FI'�terap PINNING WATER ❑Cnbrinaud lPOewuol;__,TOW�Fnhl II []uMmatad or Otna. cNece paatment ❑FUWad tt ❑REPEAT SAMP,E Prmmue ebotom presann Lab e� ❑UMIHited or Dmor__,_ .. REPEAT mu" Gale_—J�/^_ INenOUP roLfom Pnuncs Wp1_ Oaks SOURCE WATFR Soema a❑$ ❑Tots Colo. ,491 CONSTRUCTION,RFPA aU Col SOURCE WATER IRS []F RAW S ❑ ts a❑$ To Coulemt ❑OTHER(Sppe,,;, .__ .rEM CONSTRUCTION or REPAIRS �]Fecal Ca c,,% REMnRNS El OTHER ISPw1YL_. / , - .. REMARKS lue USE ONLY)DRINKING WATER RESULTS — __Gg•a. 8PS',f's' JNSATISFACIORY,C011teme Praeant (LAB USE ONL DRINKING WATER RESULTS ❑SAT!SFACTORV, REPCAT T Ca lema pbum ❑UNSA•ISFAC'ORY.C*..,e a pem•rt SAMPLES E LOIN pefwl ❑E_CI a0unt •�$nfISFALTDRY, C."b" abaPN REOUIREO L—Facal PnfA.t �u FpFN Wont SAMPLER ❑E.Cob pMfeM ❑'A Cat abwt REOU.REU ❑Fecal pram ❑Faed absnnl OTHER LA80RATORY RESUL75 E.CO TOTA,COUFOPM „ /BOO mI J _n00 ML OTHER LABORATORY RESULTS _ FEGLCOUFORM,___IIOO mi PLATE CUUNT_lml IOTA,COUfORM_nfq IT E.COL1 1100 ML _— ANOTHER$AMPLS REOUIREO FECAL COLIFORM_„_/IpO nN PLATE COUNT SAMPLE NOT 1 ESTED BECAUSE TES'UNSUITABLE. ANOTHER SAMPLE aEOUIRED UITABLE BECAUSE. G SanP'•totlotl �Cormuant9HiW SAMPLE NOT TESTED BELAJSE: TEST WNSUITABLE BECAUSE. ❑W'onE CMR.INe ❑TNTC ❑Samaa too Wo '❑CO3Im"t MOW N ❑Ineompvw I,— Wrong CpnianW Cl Typ10 eutvw �TNT! InOtlm pl0 tom ❑Ea<su d•on P ZITurO,tl cu'MHi C— ❑Eawn$EE REVERS!St06 OF GREEN COPY FOR FJtItANATION OF RESULTS aebne NO N0.p041gl GATE.nMF A[CENF: AECINEO By SEE A q4[.I [OF OR EN C ►'/FOR KP NA71ON OF RESULTS ,.aB ND Pp�G'SI MrE,n4ErKCPKn nlC..f�ev bssll�11� a:a -I. s 3y`tl6 0.1E AEPOPTCD 1UeOAV AY p . �I/ 3 '� OaTf PEPD 1`ED ' ABOM 33S-q 3 S pW eEa OeI PEV MA S OM CEIVi ER CCPY cel AFT_ft —•,.. MAR-15-2001 7K 06 06 PM K:NG CO FAX 40. 2968431 P. 03/03 I IPa l Laucks Testing Laboratories,Inc. LauckS Testing Laboratories, Inc. 940 S.Narnay Seattle,WA 9BI OB 940 S.Harney SealLe,WA 98I38 WATER BACTERIOLOGICAL ANALYSIS WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION READ INSTRUCTIONS ON BACK OF GOLDENROD COPY I SAMPLE COLLECIION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY IC instruettons an net famoWBq Semple will be rejected. IF inatrucdom are net follow".temple will be miected. DATE COLLECTED TMEyDCl COUhTv NAME DATE COLLECTED TIME „LE 0 COUN'rV NAME I AgRrR (Mv vrAA � V PE /� o �YSEM ❑�' k1n� 3 1 61 jZAM ❑PM j✓�I�Ay — it TYPE Oc SYSTEM IF PUBLK.'SYSTEM.COMPLETE: TYPE OF SY9TEM IF PUBLIC SYSTEM,COMPlt1E: �PUBUC CoUBLIC l ❑INDINowI LD.N0. t S S O L CIP A GROUP ❑NOMOUK 0 f g S a Cal- UP eM,n.u.rw (J 1.0.N0. Iaa[I IND OUAL NAM OF SYSTEM OF SYSTBA 1 n T TL SPECIf Nw.EAf P M co,,�LGTED TLAtemON840 � EKI 511 ^ � �1EREsywLE COLLECTED TEIFPNONE NO. 211 Y 44/933 ApJAD Q SAG o#61 !Lzgjj, jiq-II 3J Ilvu LS.t e4 WENING L SAMPLE COLLECTED BY.(Name) SV OWNEWMGR,;INynel EVENING S/♦K�y�r/ SNM COLLECTED BY.Name) 5�'/�/EM OWNERAIGR.:ryuaMl O atw %M a 1M YVLAI� 1`� SI311_ SOURCE TYPE GROUND WATER UNDER SURFACE INFLUEN IE SOURCETYPE UGMUNDWATEAUNDEMSURFACLINFLUEtiCE ❑SURFACE Istill a, ❑$PANG [3►URCHASEO or❑,OMBINAT!ON ❑SURFACE WELL ar ❑SPRING ❑PURCHASED er C]COMeNATION WELL FIELD INTEPTIE rOTHER I WELL FIELD INTERTIF, mOIIIEA p EPORf TO m F t Nam AoOnae m" C D PORT TO Ml N. Addme an"Lp pet tyn ) �52 me 90 37 .P . ids�S' TYPE SAMPLE knack only Onam MIS COlumn) TYPE OF SAMDLEIOAack PnM One In Mia cdumnl ��/��'JTINE -1 ). ��/ AOUrNE ����'''""'''"NKu WATER ❑Chgnnale0 IRIWOuaC`Taal Ft ❑D DRINKING WATE9 uch—aeo(Amid—_-Tclel_Foe) I eN%k bNbnAnf ❑Fltertl [Ha[k IM"Vt uallend I ❑Unvoloteo er Omer ❑Drinateo or Omer_.._ ❑PEPEAT SAMPLE ❑Pn REPEAT SAMPLE Neua[olibnn"IV" Lab!Data Provlam oa eoaferm pance Lao s_,__ _/ /__ —. oath ❑RAW SOURCE WATER Scum!a�$ m ❑Too+chum, ❑RAW SOURCE WATER Swm,a C []Total COblom. CONSTRUCTION Or REPAIRS ❑vocal Coub'm N OTHER M'eONSTRUCT�ON or REPAIRS ❑Fecal Callcrm 1 Pa['NI OTI ER(Spectrl__ ., REMARK.Yoe- �JPSSS REMARKS. RAB USE ONLY)DRINKING WATER RESULTS GAB USE ONLY)DRINKING WATER RESULTS ❑UNSATSFACIOAV,ColAonn,plahar, ❑SATISFACTORY ❑UNSATISFACTORY,CDIltonna Poo^t ❑SATStACTCIN, REPEAT ❑E.Cell Oreaenl (�I E,Cel�ae..rt cokrorma Abwnt I REPEAT (^ CATlnrm,.,trcJnl REQUISAMPLTED ❑fpeal PMln{ rLrJ,Focal abaenl I SAMPLES L•E.COII pgpJn; ❑E.D01.ae:Anl REOUIREO REQUIRED ❑Fecal Pnu)Ot ❑Fa absa�t _�OOTHER WOPATOIW RESULTS OTHER LABONII DAY RESULTS TOTAL COUFOrII 7111 0ml E.00 _/'00NL TOTAL OOUfOAM n00m1 E.OOU 1100 ML FECAL CCUFOnM_,H00 m1 PLATE COUNT_Iml FECAL COUFORM-,_„/100 m1 PLATE COUNT ANOTHER$AMPLE PEOVIRED ANOTHER SAMPLE AEOUIREO SAMPLE NOT TESTED BECAUSE'. TEST UNSUITABLE BECAUSE: SAMPLE NOT TESTED BECAUSE'. TEST UNSUITABLE BECAUSE' ❑Sampla too old Cl CohN."pow h ❑Sy pla too 0'a L]CeMuvu Browtn L}nJ{Wnr10 conWMr Q TMC ❑Ill Cpmamp ❑TNTC "nccmpeM Icrm T�N4 Lusen ❑IoeOmPlel!1p,r11 ❑Turbiu eUlu,a ❑—__._ ❑EAcuS".OM ❑____ Eccett ooena I SEE REVERS[$108 OF GREEN COPY FOR EXPLANATION OF RECIJLTS SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS LAA,q.p 010'TW OAT[.TIME AEa�no PECEAll Wrq PDG+SI DATE TIME AECENED RCCCI100ev OAtT.AEPOPTFn y,ECM >\ DATE"Elva M,eORA AY . ��jjjFFa]jy// olItm aN FNTE UP CENTER COr'Y Pwr w404a^v M9v1 MAR-15-2001 THO 06:05 PM KING CO FAX NO. 2968431 r. ueluw wua-RN 1e91Mg Laboratonesr Inc. 040 S.Haney Seettle.WA9B7DS Laucks Testing Laboratories,Inc. /WATER BACTERIOLOGICAL ANA 940 S.Harney SlI WA 98108 LYSIS WATER BACTERIOLOGICAL ANALYSIS I SAMPLE COLLECTION:REAO INSTRUCTIONS ON BACK OF GOLDENROD COPY It InshuctbnE an I followed,Sample"be relected. =AMPLE COLLEC ION'READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If InetruOEwne en r 111011ewed+SAIMPIS WAN be nleoteo DATE COLLECTED TIME COUNTY NAME Alowl DAY YEAR 1 OATECOLLECTEO TIIA COLLECTED COUNIYNAME TYPE-SYSTEM IF PUBLIC SYSTEM.COMPLETE T/ly '7 ., 'RI AM ❑°FA A Ill PUBLIC TYPE OF SYSTEM I IF PUBLIC SYSTEM,COMPIE'TE: ❑INDIVIDUAL .ND. 7 I g S O �, Cl A GROUP &]PUBLIC C GROUP Ir.+a+.I+.I.. ' ❑R+OMWAL A B NAMEOF YSTEM Pnw RaYt wa..rl • D I� Rw vi (N/AfMED sVSTF1A •..ram S I w�E lI- -W'TELEPHONE N U � DAY - (833 v S, :L t ya.�zzD" a�PN«eE Q44-/P33 I �" rt n //oo GNO•�. EVEENING ��N <<oo . I�7 - sA CW.LFCTED By'IN EM OWNERIIp q,; wnel SYSTEM I t 70� � /� S/K�iLw//�I 4 $A/MPLECOLLECTFD BY.P--Ymel SYSTEM OW NER/MOR. 'R�nel E TYPE SOURC GROUND WATER UNDER SUp CEINFLUENCF -+•� �Y^ ❑SURFACE J1WELLOr ❑$ORING SOURCE ttpE GPOUNp WATER UNDER SURF CE INFWENCE ❑PURCHASED or❑COMBINATION WELL;' INTERTIE WOTHER ❑9LAFACF &WELLW ❑SPRMG PURCHASED COMBINATION BE pH Off 10. YK Nane AWlnaa en WELL FIELD MTERTIE or OTHER /1 vu�w.K•Gi QL/.J r TYPE �IgU�_ PE SAMPLE(cIICE onh ona W yIs eeNwrutl wMlaR�c+. UONE ClTYPEpF SAMPLE IMecM only am in wF<dumnl KINKING WATER tJ CMrN eMfae 1PaebWl _iota c A 0 Cn4 reotm.nt ❑Fthl AINKWG WATER �CnIMruIW IReHOP�', _-,TOMI_Fna7 ❑Unbaated a om.r Mca b.almant ❑FinaaA ❑REPEAT SAMP.E ❑Unbaued 01 pp oAl ochfic I wataneP I'D Ii. ❑REPEAT SAMPLE Dais _/ / Pter+Pu•MINPm1 P•a..nCe Llba�,�_ Data ❑ SOURCE WATER Sour..a� m ❑Tolm Covorm I—T�1 CONSTRUCTION a REPANIS ❑Pal Cc)I" ❑RAW SOURCE W nTER SPYn4•�S I I ❑Tetal Coll ❑OTHER 15pooM.,._.__ -2TEW CONSTRUC-,0N or REPAIR$ •—u ❑Fecal Coworm ❑OTHER ISna h l___ REMARKS, /.,.Q s- J—___ REMARK$'. (LAB USE ONLY)DRINKING WATER RESULTS - ill USE ONIq DRINKING WATER RESULTS ❑UNSATISFACI CRY,Col*. .p j lnl ❑SATISFACTORY. REPEAT ❑E Coo Dresenl Cal I_ abeaM ❑UNSATISFACTORY Cow,,p+.•.nt ❑SArSFACTORY. SAMPLES ❑E.Cb1 ab•ant olilOrm•ab>YN REQUIRED ❑FallPncont ❑Face al REPEAT ❑E.COI-Preswl ❑E.CoII ab.V•nI pEW RED ❑Fecal ore-,enl ❑Fecal Ill OTES HER WOMTWW RESULTS OTHER LASOMTWY RESULTS TOTAL CONFORM -, _nOD ml E.COLT 1100 ML -- FECALCOUPORM „_nDo ml PLATE COUNT_/ml TOTALCOLIFORM_,im., E.00LIA_nODML ^` ANOTHER SAMPLE REQUIRED FECAL COLIFORM /100- PLATE COUNT__Iml ANOTHER SAMPLE RECOPIED SAMPLE NOT TESTED BECAUSE. TEST UNSUITABLE BECAUSE. ❑Samp4 too 04 ❑U.oneull 9mant SAMPLE NOT TESTED BECAUSE TEST UNSUITABLE BECAUSE. ❑W'wQ momm.r ❑TNTC ❑Sama4 loo WC ❑CRnMnt w.th ❑lFcomolal'I" ❑urble C.wa ❑WW 'u contamv ❑TNTC ❑----- ❑E.ou dl [r�Ietomplmo loan ❑Temp"Itl 0-- ❑Erm•ewr4 SEE REVERSE SIDE or CREEN to"FOR ENPLAIMMON OF RESULTS W ND.A IMImEI Da�ET TME�NEO RECENFO W _.L1EAEVVft5rSIO9 OF GREEN COPY FOR ENMANATION OF RESULTS IM YD nOK:`SI Oatl.nMEAeC6NEn IRFENFD B� b'a5l3ltC( I 3:� - S �y�t'6 C t�:' w ' tMtE PEPDATED UEOMi AY I 3 'i 3 � S-� D.TE AE.ORTEO � UBOM I.•MA.F J 3 � er CENTER ccPr I� �•�«���_-,_ MR-115-2001 THU 06:06 PH KING CO I•Hll nu 4a004Dl 'are., Loucks Testing Laboratories,Inc, ^ Loucks Testing Laboratories,Inc. 940 S.Hill Seattle.WA SS10B ( J 940 S.Harney Seattle.WA 9B•08 I WATER BACTERIOLOGICAL ANALYSIS I WATER BACTERIOLOGICAL ANALYSIS I SAMPLE COLLECTION.READ INSTRUCTIONS ON BACK OF GOLDENROD COPY SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY N instructions an not followed,sarnple WIN be rejected. N ita rtrutDo•a ere not followed,eemPM WIN be rejected. 1 DATE COLLECTED TIME LpII mO IC OUNTY NAME MDXE LOIIECTE TIMELOI,LEOfED OOUNTY NAME ( ea]IItrI av .uR `c ' ESL �A 5 AM ❑pM �;I V 3 t t71 ®aM pPN kivr ETY�IPE OF SYSTEM IF PUBLIC SYSTEM.CtNaPLETE: . W PUBLIC TYPE OF SYSTEM f 'JBUC SYSTEIA.COMPLETE: ❑WOMOUAL LD.No. ' B S l7 �, cRInE waup "a nromDUAL LD.Na. ' S O l� CR1CyE cO w hano W1R.Wsy (J (�A:\J NO 4a/Iw11MM11 OF Y$1EM NAME OF SYSTEM SPECIE N WrpN NPYE COLI&ETEU TELEPHONE NO, I II �E (SKIS 'A 221 pAY 7G -{�l9 J 3 ERE LE COLLECTED TELEPHONE N0.- Ii� �,S.W 11 �Z ALLf !� lStq 1�iol YZo -1Q33 44-- tY EVENING( 1 YOf 1 EVENING SAMPLE COLLECTED BY.(Hamel SY o ''R(MGR•:INema) SAW COLLECTED BY,Memel SypM OWNERAAOR:(NoTo ON.. fN J O : �6i m 1'1 QIH- SIJW SOURCETYPE GROUND WATER UNDER SURFACE INFLUENCE SOURCE TYPE,ET GROUNDWATER UNDAR SURFAC INfWENCE ❑SURFACE 14WEUW ❑SPRING ❑PURCHASED or❑COMBINATION ❑SURFACE EWELL o, WELL FIELD PRERTIE BOTHER ❑SPRMIO ❑PTEATIF PURCHASED ❑C oIllem pN WELL FIELD eRERmf, arO111ER 7f{�IIEPORT TO:mNE F NNn Adonis%WV Co TO' �Or r0 N�.. AoanaF an r LP�,o"I /`.Scams 2LCL MD✓thda w.e.Hlron SO$j � w.HHArnV aQ�j TY MPLE(Etreck only one in this mlh nnl TYPE OF SAMPLE(UecA any ono M this caumnl ROUTINE 0r�Chlonnwoe ROUTINE RMKWO WATER W Mavtlml:_ToW�finel ❑ DMwmateD lRealtlWt. 7mal_FraN OPoNKING WATER crack lrtgblwM ❑Fllleratl I cMck tTaMaMM1_-- ❑UnvabNa ar Omr ❑WanaNe r Weer_.. ❑REPEAT SAMPLE ❑REPEAT SAY-LE Fnlv-Va colilonn Prosrlce Lab a Provc.0 ro111rm pnrmcc Leb Ir Data _/-_!-� I Dale ❑RAW SOURCE WATER Source a❑$ m ❑Taw Cakrm ❑RAW SOURCE WATER Seu1cs r T ❑Yale CohiKew loml CONSiHVCTION a REPAIRS ❑ie•ew Collbrm g NEW CONSTRUCTION 01 PEPAIRS u� ❑kcal Collleme OTNF.R(SPrelhl ❑OT,IER(SMOIy)_—_._ REMARKS 6 (LAS USE ONLY)DRINKING WATER RESULTS tLAB USE ONLY(DRINKING WATER RESULTS -- [�uNSAnsfncto,7C,1 ;Dnranl ❑$AIISFACTogY, ❑UNSATISFACTORY,cal,m„p•.,nnl ❑sAnsrac!cRY Coetomes aDrnt Co4b.ma 00eWI SAM LES ❑ en1 ❑E.Ceb ao%rnt l Pc LI pmrwf.CD aDsnl P BAM LPESE.Call I.REQUIRED ❑ mt ❑focal aDaea REOUIRED ❑Face,""t ❑foe"I msont _—�OOTHER LABORATORY RESULTS OTHER LAIORATORY RESULTS TOTALCOUFOnM�T 11;ml E COU _ 100NY TOTALOOLIrORM nDOml E.COLI 1100 ML FECAL COUFORM 1100 mI PUTS COUNT_/ml FECAL COUFORM�.,AGO mI PLATE COUNT /mI ANOTHEP SAMPLE REOUIRen ANOTHER SAMPLE REOUTAEO SAMPLE NOTTES%0 BECAUSE. TEST UNSUITABLE BECAUSE: SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BFCAUSE' ❑Bamae roar aD ❑L W 0Yem gown ❑❑w Ing cW Wne• RNTC ❑wmmg Roo old ❑Coneu..et g.owln❑ (]wrong a mmna ❑Twe nec4mpam ❑U for TurOa ttnrn ❑Incomplelt Lam ❑1Wb�tl dllm ❑ Escue oaten ❑ ❑E Cns peal% BEE ArAFI E SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS SEE REVERSE SIDE OF GREEN COPY FOR E%RANaTION OF RESULTS IAA N0.00-01 R1 BAR,nNt Atf11YE0 RECEIKOeT eAe H00DIG'TS) CATS ONE MclvvtO Lntcvvllos. DATE RPOATfn NeOM • pAfl tlf/.oRTE eAeOnA rn ` S ■,WRe 335-� F 3i5- I ea.1E10Q-PrY NL aR,NerW wr.nn OF CENTER COPY __.,--_ .." F tM:14-2001 WED 05:47 PM KING CO FAX NO 2968431 ;. 02 Laucks Testing Laboratories,Inc. 940 S.HWnT Seattle,WA 98108 C 1 WATER SACTE,IIOLOGICAL ANALYSIS SAMPLE COLLEC➢ON.REM INSTRUCTIONS ON BACK OF GOLDENROD COPY II inatruciionS We not fol:owee,Semple WIN be rejected. DATE CnLLECTED TWIE COLLIE D COUNTY NAME III frOnTH DAY VEAA _2;M I 1 (� 1 ❑AM J tt Jl.ti 111 TYPE M SYSTEM IF PUBLIC SYSTEM.COMPLETE: �PUBIIG ❑INDIVIDUAL CIRy�OROUP ' IrewMl,yNellee U ' NAME OF rSRM D ,[J_ E I�StA RION kSANK CQ ELECTEO TELEPNONlNO. 1'L+ P.y 10-1463 G 0 EVENNO SAMPLE.COLLECTEO BY Name) Sy;S7 OWNErVM`).:?� ` RCE WPEI�,.' GROUND WATER UNDER S,M INFLUENCE ❑SURFACE `wk�4 FIfLD❑SPRING [I PURCHASED INTERTIE EO a❑CO a M IIe TION 08 ORT TO:( nt Full e. .SE and Lw C Gk TYPE OF SAMPLE{check.01 0"In Ale eefutnnl ., ❑ROUTINE ❑l;hlwineted PlnilduAl: T.a Fmel DRINKING WATER '•�.L.. '. CtMCM VBitmMt ❑FJIMetI r ❑Unt eetei Ot 0wo' _ .. REPEAT SAMPLE ' Pnle01{COIIigm RryLeKO L'1D r —_�—_.._.. i Ode—/_ RAW SOURCE WATER Source A❑$ ❑Tow CovA E-NEW CONSTRUCTION or REPAIRS ❑Final Cosann l RENIARnS: ILAB USE ONLYIONLA CRINRINO WATER RESULTS ❑UNSATISFACTOM,CWfgme OTesent ❑SATISIACTORY, COl,ldmd ABSOnt REPEAT ❑E Cal;nnnnt Ej E Coll wwt SAKAPLES R OU RED ❑FYeul preen! ❑fees.ADAenI OTHER LABORATORY RE l `Ies TO COUFORM ,1o0 m1 E CODA- MMIAL FECAL OOLIFORM _110d ml PLATE COUNT ,ml ' _ i ANOTHER SAMPLE REOUIREO SAMPLENOT TESTED BECAUSE'. TEST UNSUITABLE BECAUSE ❑swo,o Iw dd ❑Conlluem 9rewth []wrong comamw ❑TNTC ❑HCwpwerc.m I0%,Wcuw,a ❑ E•c.EE deorn R V R N C O FAPLAIUITKIN OF RESULTS tALNO.1ToIGn SI "TT mvE nECENEO nEGCIVED BY 0'R 17LI �V3 c'; oATE"'(00ATED upo"To T 3 I 44* OwOre,Ma:PY nN 3u> -I E OP r;:NTFR r.OPY C¢t. lG3 ' 1 MAR-14-2001 GED 05:47 PM KING CO FAX NO, 2968431 P. 02 - Laueks Testing Laboratories,Inc. 940 S.HameY Seattle,WA 98108 C WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY 11 instructions we not Followed,selnOle will be rolected. I i DATE COUECT£D I TIME COLLE D COUNTY NAME .r 1 Yprrtw3 OAT YEAR : I . 1 1� 01 ❑� g1� 1-11Y - TYPE Or SvSrom W PUBLIC SYSTEW COMPLETE: �Pl1BLIC ® CI GROUP ❑INav1DUAL of YSTEM Ir�l TIONRn ESeAWIE f.OL1EC1E0 TELEPHOnf NO. Hdr EVENING 1 SAMPLELOILLECTED BY Nl I$YS;Z OWNEMN1G .: Hamel p ' RCE TYPE GROUNp WATER UNDER 9 WSACt INFLUENCE ❑SURFACE ,WELL Pr ❑SPR'NG ❑PURCHASED a❑COMBINATION WELT.FIELD INTERTIE or OTHER �it10 BTO.1 )n!FW na m0 2W:9�1.0 / F. F`�LO Lo s4 S 4Ira �a TYPE OF SAMPLE Iekeek enN om In this colu onl • ❑ROUTME Chgnnatetl(Flnidum._ DRINKING WATER To'* F.)❑ . u,,oeete0 er Omer ❑ REPEAT SAMPLE . PrenaYi CClllpm D,eHnCe LJ0 e ��...,,.. ' Coto _II_____ (1 RAW SOURCE WATER Soome e� W CDTOW Cek(am 1 r-1 1 R-NEW CONSTRUCTION d REPAIRS U FKaI Carom ❑OTHER(-Sy ,Iy) RENOLRNSI (LAB USE ONLY)0111NKIN0 WATER RESULTS ❑UNSATISFACTORY,Carl.me pn"I ❑SATISFACTORY, Coh"I aomnt REPEAT ❑E Cell MINI ❑E Coll sown &MALES REOU�REO ❑F°CJI Weienl ❑FKe s0eenl OTHER LABORATORY RESULeTT& TOTAL COLIFORM_-I100-I v E,COLT C 1100 ML FECALOOUFORM-_-n00 m. PLATE COUNT_Iml ANOTHER SAMPLE Rr.OW REO SAI'PLE NOT TESTED BECAUSE TEST UNSUITABLE BECAUSE I SNnee m ols ❑CeI1IMr11 BraAM r�]WronO conramor ❑TNTC ❑n[ampalP Ism TL,We coo. •• I R ...... Y FOR IaPLANATION OF RESULTS LAB nO IF WGTSI pATL.mbE IIECENCL nfell OeT OF 17LJ 0 L13 go A; G.' OAR nF Ta0 WONr.I xerl.s 3 0 1—1 son Ar m:o ,ran f)D CFNiK4 C:(1Fv Crt 1113 NOV-14-2001 WED 10:48 AN KING CO FAX NO. 2968431 r. u2 r Laucks Tea"Laboratones,ine. _. I �__... ... 940S.Humey Sestre,WA95108 i ` REOS.HOrney S*aM@.WA98108 1 WATER BACTERIOLOGICAL ANALYSIS WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COW SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY It Instructions are not followed,sa nple wiR be rejected. N InatruaioEs are not followed,l arnple wit be rejected. DATE COLLECTED TIME COL 1ED COUNTY MANE DATE COLLECTFD TIME COLLECTED COUNTY NAME W,,T, 04Y wM � F NONM pAv rW1 _1 (I 61 ❑AM ®PM /✓l �� ] O/ ❑AM ©PM JI TYPE OP p SYSTEM PUBLIC SYSTEM.COI/IN FI'M qTYPE OF SYSTEM IF PUBL FA IC SYSTEM.COMRETE: PUOEIC PUBLIC �'J GROUP ❑WOW)A L L.D.Ne. / g S' Q Oln i{E Ge P ❑INDIVIDUAL 0 d e NMIEOF YSTEM _ NAME OF SVSTCM L \ L -D. ✓� .YEDFIC'CCA VMEPE SA�IFCOU:-TEQ I wYLEPHONE NO. _ IP.CLI W�SAMPLI CCLIECTED TEL:PMONE NO. 13�1 � Seat f6k l�orl ( �rou. avl a EVf.NING FYmn E 1-i L�QSC. EVENING S 1AjPOLLECL eA,'vi SVST MOWNERR.1Grt'.1µynry. S�k[COLLECTE&c(Nvy SYSTEM vne) •-SOLRCffYf4 GROUND WATER UNDER SURFAtfINFLUENCE SOURCETYPE U GROUND WATER UNOFR SURFACE INFLUENC.0 ❑SURFACn?WELL« O SPRING❑PURCHASED Or❑COMBINATION ❑SURFACE &WELL of ❑SPRING ❑PURCHASED b❑OOMMNATION WELL MCI INTEATIE er OTER WELL FIELD INTERTIE Or OTHER Sfy0 EPORT roBIANti N.vn;AdOEu �o�e�, 9FND REPORT :IR+Nr Aches pCo" C-�l.i'. _�f..—l`.yel�•'L L--Fy=/= YS cfr mv,irA _S cora.lA� (Al" .ono„ TI�OcS-.� �*� sr PE OF SAMPLE(Meek OIL,one in this eolomn) TYPE OF SAMPLE(eMek enN ores A Uw column) ❑ROUTINE. ❑ROUTwE ChlomoL4M QiaatluaL_Taie_H,N) DNINKINO WATER ❑CNomaled IReRwud:�Tp11_,_.FnN 0AINNINO WATER `�- eheek boulrm:M ❑f;lemd C%Kk 1reeMonl ❑FA ea ❑Unitabd Or Otho, ❑Untlxlso or Olh«,__. ❑P,Iw.o SAMPLE ❑REPEAT SAMPLE P�ev�om colltrm prox+xe Lob __ P�wbus copblm pmsence Labe__ .- Oat .—I—.(_ Dab SAW SOURCC WATER Solace e O m ❑Told COhiv. ❑yy RAW SOUACC WATER Source a GI ❑Told Coklorm NEW CONSTRUCTON P,REPAIRS ❑Fetal COkform yp NEW CONSTRUCTION>.REPAIRS FPeal Cohform ❑OTHER(SpoclM___ ..___ ❑OTHER IIL'MARNS: REMARKS' O LAB USE ONLVI DRINKING WATER RESULT] (LAB USE ONLY)DRINKING WATER RESULTS 'J UNSATISFACTORY CcI,lolma prtsem T1SFA�TORV. ❑UNSATISFACTORY,CaEbm�e Preaanl DSfACTOM'. r-T Collo absent OoEferma Obaenl REPEAT t.COL presam ❑E.Col.a4wi ACPfAT ❑PLES ^E.Coo pnsenl ❑E.Col,atom RFOU SAMNE 0 ❑r«.II present ❑Fww aosonl REOU Rl0 IJ Fetal presto! ❑FecM ablml ---• OTHER LAEORATORY REEULTS OTHER LABORATORY RESULTS TOTAL COUPORIA.._1104)ml E.COLA_/TOO NIL TOTAL COL FC RM_/t 00 ml E.COLI,._$100 ML hSCAL COLTORM,•_A00 m'. PLATE COUNT_nrtl rCCAL COU FOAM_I100 ml PLATE COUNT_onl ANOTHFA'AMPLE REQUIRED ANQTNEA SAMPLE REO1Y,17,a SAMPLE NOT Ti STED BECAUSE: TEST UNSUTAB,E BECAUSE SAMPLE NOT TESTED BECAUSE; TEST UNSUITABLE BFC.AUSE. ❑SAmplalnodd ❑Comlwnt ytwm ❑SAm"Im old ❑cim"I, ,l 9twrn ❑W wv Come SNV ❑TNTC ❑Wrong eamwv ❑TNTC ❑PMYinview 10m, ❑Turbd c0 vt I ❑,r .Olet 10, Tmbd CUN. ❑�_..__._ ❑fem deb. ❑ .._ �E.ew demob RF NOf OF GREEN COW FOR EXPLANATWN OF RESULTS R F .E SID Of ►Y FDR K►LAR4TION OF R SUITS LAe NO Mm;l IWC nMME REC0,0 A[CErvED ev WNMPdGI*51 Oa•F,THE AECEivke 'AECFrvE09Y 73�7�11�00 1) 7 sr tJ C9171319 o��c IN.vn.ca— ,nponATo��Y cA*E IIEroATc� uaorvoo I rh Ub � Ib 1,5o FIMMW 11 0 '\ PW MaEm'RN sal OPT 1M M PIr e.,b OP CENTER COPY OP CENTER COPY __ r NOV-14-2001 WED 10:48 AM KING CO FAX NO. 2968431 P. 03 — Laucks Testing Laboratoritas,Inc. .-. LaDMr Testing Laborntorims,Inc 040 S.Hamer SAARIe,WA 9810E . 9A0 S.IEarnell Same.WA 9E108 I WATER BACTERIOLOGICAL ANALYSIS WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY SAMPLE COLLECTION:AEAO INSTRUCTIONS ON BACK OF GOLDENROD COPY If Instruceoma are net followed,SempN w,I)be rejected. If Instnlotions are not lonowed,eareple wa be rejected. DATE COIAECTEO TIMECOLLECTED com !%we DATE COLLECTED) YIME COLLECTED COUNTY NAME M(alnl OIIY rtM _ L•-qr MONM GY YEAR J . /b t � OI ❑AM 5aPM IYtj If 't of ❑AM GPM /"I TYPE OF SYSTEM e'PlMl.lO SYSTEM.CAaY1.ETE: TYPE OF SYS1 CM IF PLASLK:SYSTEM.COMPLETE; �PtIEUC ppIIPUELIC IW7MWAL e @ CIRC EGROUP JR •� -Tq C.D.N0. I O ,J O B ❑INDNIDUAL 1. I 8 S O L ��R NAME OF YSTEM IPn.r ecr 1 wumeM — /�� NAME SYSTEM lLP SPECIFIC ON SAKOU COLT ECTEO IELLPHONE NO. FC IOC WHERE SAMPLE cpuccTEp TEIEPNONE NO ot•T �ql.`F� UJ DAY t 1 I DcJ IE•�9'rtr.b DAY I 91`jG15/ EVENING I I K p a f EVENING I SAMI'lF UCCTED BY IN;,m^I SY IEa .:I emq SA6P E-XLLECTED V Novel Sy .MOW'IE :INomq led BUURCE TYPE., OROUNDnWATERUNOENlURFA INiLUENCE SOU GROUND WATER UNDER SURFAIfiNCE pSLViFAOE�NEII.M [I SPRINGpPURCHASFOor❑COMBINATION SURFACE wEll«WELL FIELD INT$RTIE «OTHER ❑ CB ❑SPRING ❑PURCNA$CD«p COMBINATION WELL rIELO INTERYIE «OTHER S PORT TO:prnllpll NaSu,Adnrn. 'p Cotlal S R ORT Tp; - t N AdCreN antl'[ pj°c� ��c k � sg��L�P �nC w.c,nMm.. 4oSY' W ~ 90M IYPEOFSAMPLE(checKonA,one In thl•:column) TYPE Of NPLE Ic1Aco onN one in Ode cMumnl ❑ROUONF Cnlo,r,atod(A.Pd Y�--TOW_Fgal AJU�'4% OIIINKMG N1 ❑ p DRINKING WATER ❑Chlonnalee tfwwdu.it__Twat_iwN cn«I,voatmanl []U-tMatFln~ ehwk treatment ❑FIIHM ❑UrInaIW«Om« ❑RF.rFAT SAMPLE ❑Un:rwted or Olh« _— P,WIOVlC01-10IToft'WACO Lees _ ❑REPEAT-AMPLE '- Prwvut CWhxm preoonCe UP CAN Date RAW SOURCE WATER Soumo a❑ m ❑TOLV Confoml p RAW SOURCE WATER $once e Es] ❑Toth Cd.tonn �NEW CONSrnUCT10N or REPAIRS ❑Fecol Co,.lorm JR NEW CONSTRUCTOR a REPAIRS pFeca Cunlorm LJ OTHER ... []OTHER ISPo0y1-__�C _.,+ REMARKS:�,p• r.� c (� _ REMARPS: �•b_ —_ (L/10 US!ONLY)DRINKING WATER RESULTS ItLPM USE Own DRINKING WATER RESULTS ❑VNSAT�:d•ACTORY.Co4lame puem TISFACTORY. UNSATISFACTO YC Colds n nanl ,�/��S`AT—ISM—CTORY, CoTfolmt ap:onl ❑ m P "C.00"I.bm" PEPLAT ❑F.C«�««ant [�E Cd�a0ocn ❑E.cow pru«,t ❑E Col alNnn SLQUInc rocal p teMt F."I.IeSent SAMPLES ES REOUIOEO ❑ ❑ _ ❑ ❑ eui;A:teo_ PKm pNMeM F OTHER 4WRATORY RESULTS I _ `- -. OTHER LABORATORY RESULTS TOTAL COI IFOnM _;100 ml E.COLT,_11 CO MIL TOTAL COLIrOFWI n00 ml E.COLT_A00 ML ^— FECAL COUFOnN._/1OO mi PLATE COUNT__nnl FECAL COUFORM__,1100 m1 NJI COUNT_hill ANOm ILA PMPLE REOWRED I ANOTHER SAMPLE F7.)UIRED SAMPLE NOT TCSTED BECAUSE: TEST-1UNSUITABLE BECAUSE SAMPLE NO TESTCO BACAUSE: TEST UNSUITABLE OECAUSE'1 pSamplaItvad LJConhwntpv to ❑Se L'']lww0camanc' `❑TNTC m eelre a0 ❑ NTC tQOM LJ HCCmpIWe rum, p Tmeid cP ❑MAo^9 ewtan« 1]Turel I l ^ ClmLY,mpaH t«m []TVrNa dUlum LJ._.____--- ❑EtMN tleprp WE AIVERSE SIDE OF GREEN CO�iFOR EXPLANATION OF RESULTS SEE RlY[ASE SIDE OF GREEN COPY F011 EXPLANATION OF RESULTS LtaryO CrtF.nML�ECFMO REc"Y"t OT Uk"w 06GIT]Iy02 Osl71� 01DArC AEPCARO 'TO150ISO KH wePnry w, ' NOV-14-2001 ICED 10 49 Art K:N; C FAX NO. 2968431 P. 02 Laucks Testing Laboratones,Ina I --- - 940 B.Narney Saatt'e,WA 99'CB - 94OS.Harney Seattle.WA 981 OE WATER BACTERIOLOGICAL ANALYSIS WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECI!ON*READ IFLCTRUCTIONS ON BACK OF GOLDENROD COPY SAMPLE COLLECTION'.READ INSTRJCTIONS ON EACH OF GOLDENROD COPY If InsMrctlons are not folMwtl,sample"R be'elected. It Inatructlona aye not followed,simple WIN be relocted. I DATE COLLF- ILU TvIE COLLFCifEO COJNTV VMIE DATE COLLECTED T'I,COLLECTED COUNTV VAMP WWI, avy Y%M ��;�y_ Noll / W. run L r�C� III ❑AM �PM /✓IA 11 O/ []AM WPM t� TYPCOFSYt"I'lim IFPUBLICSySrEM,COMPt FTC: —� ppTIl'PF OF SVST IF PUBLIC S'ISTEM,COMPLEIE. �PUOLN:n INpIV GRO UP ❑INDNIOUAL 1.0.N0. A GROUP G E.P)LIAL EaE F( SO L P.weerw l Iwnw W`+vaae NAME1 OF V$TEM NAME OF SYSTLM MIF=AJOIN 040EnI Still r' �yp�NE NO. IPyC �'7 WNELLIIESWPL2 CQL4fCTE0 TELEPMONENO. Iblo Orr CA%I- FA.+ .CO" Pori IZr, IPfoO, V NK kff gfu t-4u- Z fYFM b -- LLECTACAO�DO,Y.INnm.i svSr N1 OWN11(Narl �OLLECTE�V.Name) SvETIMOWNf"GR.'jN&,,o1 soURCE rni "ORO'JNO WATER UNOEA SJRF EINFLUENCE SOLPCETVPE GROUND WATER UNOAII SPUURC EINFLUENCE ❑SURFACE M WELLIv D❑SPR,NG ❑ NTIE'YASED Cr❑COOMOIIMTICN ❑SUAFACE Real RIELO❑��❑eRERnEA5ED 0 _']COMBINATION or O $jyp E"T 'u At F AlnPc ONO PORT T IPn'1�WI N ..Adw" 0 DOOM L.1as, ll eJ -- S pLc1c, EA.a 11"'1 1.11 a/' H� .. p LA_ .,Ww.xa,a YU NN.wrnTw PE OF SAMPLE(eniee Dolt on.m III c01umn1 TYPE OF SAMPLE(eNeck pnly one A W4 Celumn) ❑ROUTINE (]ORiemalW lRern:w'._TOt1,_,_,FRPI ❑DDFPWNOWATER ]ClncnnawglewlIat.._Two' Fleel DRINKING WA•EX elen OeWment ]r;Teretl M.eL lnutmant ❑emerb ]REPEAT SAMPLE. Unt REPEAT ..t.a ar other--. ._ ❑uetrest.a or Dm.r. ❑ ] leColl E OFrvmlu CCNbrm areal LW a —� P`wuN CON'prm pmSY,:[ Ub Imo__ -,- O.0 Date_/_---/-- [�]SAW SOURCE.WATER SOOCt t C © ❑TOW eoldvm i r-yMW SOURCE WATER SOUee e T.LY cof NEW CONSTrWcnON or REPAIRS []Fscal CO1.10m, ANEW CONSTRUCTION Or Pial �FacAl Coitterm []OTHER;5pOCV___-.__. ..--- I ❑OTNFA ISPOCMI_...__....—... RL'MAAKS'. oil RELYWKS' ___ IAB Usi ONI 0111N%INGWATEA RESULTS _ (LAS USE ONLY%OAIMENG WATER RESULTS [']UNSAT16FACTORV.C:IIIprTa p•esem AnSMGTORv ]UNSATISFACTORY,COPQ, 1 pNienl r OSFACTOR'/, Ce'=loth,:atN^I CWUenmi ylvenl AWAY []E.CMI p.Wool ❑E,Cal-av¢enl I ACPFAT ❑E.CPII prAI 'E.CON QV!,m SAMPLES I� SAMPLES UtAPn r1 FL'CaI Ons.n! []Fec4 aOFmt AEO l..l Fwll pmnt ❑Feew vOtMt REOUIR(1D u -- OTHER UJIMORATORY RESULTS DINER LABORATORY RESULTS �- VOTALCOLI"Ot...nlMml E CCLI_/ICOML TOTAL COL.FORM_-/100 At ECOLI. _/100 ML FSCAL COLn'OAM,. ,/TOO It PLATE000NT_ /ml rCCALCOLIFORM_,NOOM PLATE COUNT—"I -^ ANOncEN SAMPLE AEONpED ANOTN9A SAMPLE REOLP EO SAMPL61401TLS1606ECAUS6. TEST UNSUITABLE BECAUSE. i SAMPLt NO•'ESTED BECAUSE, t EST UNSUITABLE BECAUSE. ❑SAmot.lot We ❑comwom BrOwe1 ❑Sam"loe*to Confomt weyPN ❑WMfq cam,YNN ❑TNTC z w.Fg camm,p TNTC ❑ ❑WeynplplC 1prm •uXBdw.,AE `AcempIN.'Pm` TVMNd NnI•e f.SI F E N C PV F A %I NATION Or A WLTS A V SF SIDE OF Gass L4 COPY FOR E%PLANATION OF I Lf5 1AeNORtNpl l Tws,Two NEcei; RLDtNE00v WNo(IDG'SI Ce•r'w1NEGc�..0 eECEMoaV MTl 11LMDPT[0 W'YNTC`rc DATE AEPOeTIM Il 0 1. o1N PtN.,•, �.50� I ��,P,..,i OP CENTCR COPY _ OP CCNTER CC=, v NOB-14-2001 WED 10:4B AM K;NG 00 FAX NO. 2968431 P. 03 1 Wucks Testing Laboratories,Inc. -. Laucks Testing Laboratories,Inc. 01O S.Harney SPRNG.WA 9810E 940 S.Harney Seattle,WA 98108 WATER BACTERIOLOGICAL ANALYSIS WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIOS ON BACK OF GOLDENROD COPY SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY It Instrupean:l are not followed,Semple Will be m*11ed. It kmtllawe,ls ere"I followed,ee,npte will be nk0tad. I IIO.ZrMTEt.'pLLRCT80 TIMECOILECTEJ COINTFN SATE COLLECTED TIME COLLECTED COUNIV NAME 0AY YF0 L.-YS_ , NoN1N aV •SARI _ .T LI(IG OT ❑AM �PM �1St II I ❑AM G]PM k�a1 TYPL OF SYS M n'AIAFI.ir,SVlTFM,fbaFPl[TE: I TYPE OF SVSI CM IrPUBLICsystrim.0cuptm. PUaUC LJ bNOMOLML D. 0. B INDIVIDUAL Cl ORCUP p :1alN: a �'� / Q ClCIRCyE BpOUP �❑�,•.,...si I.O. O S L B NAME Oi YSTEM (\1iJ\ N 1 F SYSTEM /�e n QMS� L_ d Felt _ .7PC ON SAM IEIEPHONl NO. g F XC RrEA^M-eOpLLECTED TELEPHONE NO (/O1((W� °T1r • urc DAYS I 13 �Wl�rf" S*L bl DAY( I 4/e rf E.We,f/! �ENINO J0 L1 , Vl or FVEMNGI - I !"AI OLL CC rEO IV(Numnl IF 9 MOWN" R.(Veme SAMPIECDLLECTen RY:IN *I I SY M OWNERINIZ.101 mill.4 Q � r��-� W ��Al•Y1 B0. 'CE'vW; L,CAOUNO WA`EA UNOEN SUPf WFLUENCE SOURCE TYPE GROUND WAT@R UNDER SUTKA. WfIUENCE Q$ISIFAOE �Wl FIELD �9PpIN0 '-1 PVRCNASFO v❑COMatNAnON I ❑SURFACO WELL or Q SPRING ;]PVPCHASCO Wr Q COMBINATION _ WELL fIlLO '-•IhTERT1E POTHER WELL r,C.D I.iTEROE PIT OTHER 5 POW TO'. rmtLyu N+�,•,AtlnmAym�1'p CoOW) I S R ORi TIT:prAtSLfa N:Wn/.AtlWna•m12 S,.i �ml.--LSIRh�-l IL'n k er C tty�— �jT QL� �. ._/l 9051 TYPrE�TOF 9AMPL E ICn•ck only onn to,An:<olumnl TYPE OF SAMPLE(cl Il oR•m INS MAW"I L�ROJ'1NF Cman..atoo(Ill—Tow_1NW ROUTINE OnINKINGWATCH Qr1 ❑L`RINl WATER �G�ttCMmmalWalM4aua1;__TOtaI_FNN FN•CA"'Ilmer't [3F'll DN,cgA.Atl,ont L]F,N$Md REPEAT SAMPLE REPEAT QILTIHanow0mv— -� Q UNIISRba Wr OIM1P_ errouA n _._ (' olSAMPLE F •orm pNrr'nc• LWD• ..__ Pmwua canpm oMWnce Lab•— RAW SOURCE WATER Soum.a $O m ❑Tow Co eoml I n RAW SOURCE WATER Soule•C `J Tatd Cailam NEW CCNSrAUCTION or Rmll ❑Feca Coll NEW CONSTMUCTION W REPAIRS f•ca c.11 m L OTHER(GVWCIM_- []OTHERIBPWCM__._p REMARKS: REMARKS. I"W UaE Oel DRINKING SINTER RESULTS I tL ao USE DAILY)DRINKING WATER RESULTS LJ UNSdtMCTORY,Gb!orms a uo K GrADTORA UNSATt$FACTO eY COnlermn pmant r SAtISFACTOAY ^ IN"WINN CW IbrnF aslant Al LJ P.Cm.punt U I.ea110CCni All E.Coo Wea•ni E CtM artAr PLEG r•ea peaMl recal.e•em SAMPLES DUlREO [] Q pEOWPCp ❑r•rw nm•nt Qhc.N;b•rn _ OTHER LAaOMTDM_MSULTS OTHER IYMATOWY RBWLTS ^- •TOTAL COI 19CTM--11 OU ml CCOLI__MCO ML TOTAL OOLIrofem r1 of E.COU_1100 ML FECAL COLIFORM_siOOm, PLATECOUIl FECAL COLI FORM __MOOm PLATE COUNT_AM .•� All IER SAMPLE RADIOING ANOTHER SAMPLE AEOUl SAMPLE NOT TIC"AD"CAUSE: TEST UNSUITABLE BECAUS& SAMPLE NOT TESTED RRCAUCE: TEST UNSUITABLE DECAUSE. IRampN tro oM eonnwnt Ql I Same•too rI4 ❑Cormi nt gmm" NAG"N N.anp 1N7C Ill CDnlamM QTl Li IMemilwo low TugA CIj%m Ircomp•1•TWNn G,raltl 61 LN [.] Clot", ❑ ❑E.crea m+& 30 INVERSE 310E Of ORIGIN COPY FORIAPLANATION Of RESULTS I SEE REVEASE Sol OF GREEN Copy FOR ESPLANATION OF RESULTS tAn NO.PbC'P I ACCl ev LAN M1O DPGITSI DATE 1I4CtK:ENIi. ECENCD eV 05 MVf.pCromLD Up01+nV I NT¢AfnDA1CD .A00M10 ISO �' t PIAR-06-2002 WED 05:30 PH KING 00 FAX NO, 2968431 P. 02M — Laucks Testing Laboratories,Inc. -- + 940 S.Harney SeaBlo,WA 98108 WATER BACTERIOLOGICAL ANALYSIS 1 SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY N mstrucB•IUl an not fofl W d,sample will be rnlocted. I� OATS COLLECIEO Tya�yy�y� CTEO COINfY NAME I MONTH MY S 02 FdAM TYPE OF SYSTEM lF PUBI IC SYSTE10.DOMA ETE� �'PIIBLIC ❑VQMOUAi ImEE= 7n T NAME OF SYSTEM ,•' 9ECM CATEYIW*KSAMRECOLL0--Ia TELEPHONE No. 1� how- 49-5 f �A• �33 ofF'ti ec�ceR �• EYENNG _ _ SAMPLE COLLECTEO BY:fimal SYSTEM OYMCNAI 1 CE TYPEU GROUNDWATER UNDER SUnrACC INFLUENCE -- ' ❑SURFACE XWELL& ❑SPRING❑PURCHASED a❑COMBINATION I - •"^• WELL FIELD WERT1E aF OTEYI_ 1 RE TO:Prc11 Fay&i o, W ZIP -S _ ' 3 fl— - e.•.NNCTJF SS' t TYPE OF SAMPLE IcNec eery onou Wa cdW l ❑ROUTWE C]Ilanvd . DRINKING WATER ❑ (Rnvdunl;_—Teul_FNW) clK eMM El re.VI ' UUPIn910d n01ner___ • ❑REPEAT SAMPLE Dan 1 . kRAW SOURCE WATER San*a m ❑Taal CobN,m NCW C0NSTRUCTK)N rr RCPNRS []fecal CG1*%m ❑OTHER RE TUB USE ONLY)DRINKING WATER RESULTS ❑UNSATSfACTOM,CoLlerms Po;ent SATISFAOrO1TY, REPEAT E.call —� flermaaCsml ❑ MnJ�I ❑E Ce4 aac+nt SAMPLES REQUIRED ❑Facd pn;Pnl ❑iacs eboNll OTHER LABORATORY RESULTS TOTAL COUEORIA_/100 M E CUU„_/100 NIL —_—_ FECAL COLIFORM_nom m1 PLATE COUNT ANOTI I1I1 SAMPLE REOIAREG V 4PPLE NOT TESTCO DECAUSE TEST UNSU)MOLE BECAUSF, 0 Sample bP qi ❑Cann ra 9M." ❑WMN a"ta ❑TNTC � ❑Mcanpla to" ❑Tw r uo ❑--- ❑Em"s as v I I SEE REVERSE SLOE OF GREEN COPY FOR EAPLAFIAI ION OF ACSUUS uB NO,0 Dell MR nw ACC[N D P'KtwOEY d8/Ci �$9�j V c,J I CA•E R[R[PawEEO IAeauT M. � I Laucks Testing Laboratories,Inu. 940 S.Harney Seattle,WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY It lnetwcums am not tolloWed,sample will be mixted. DATE COLLECTED TIME,COLLECTED COUNTY NAME MQIIM DAY YEAR 3 i7 / I ❑ I WPMI 1[ 1 ^ r\ F�TYPLE��_O�F SYSTEM IF PUBLIC SYSTEM,COMPLETE: 4�ryOAIC � ❑ roY 1 IXyy LD.No. 7 ( U c V 9 P Iww.d+r n.a.cx NAME OF SYSTEM LOCAn IRTIERE SAMPIF TW TELEPWK fi!NO. r.CA.. i-r.i i• JL.., DAY :E(1 _ I�.IcT. S�4 -7+82 I S�ENM3( ,. 1 ••... • SATRE OOLIECTEO BY(Nrne) 8Y`�'T-�a WR�ER(l'M`1f/� J�y) SOURCE TYPE'aiGROIINO WATER UNOEP SI1i�ACE INFLUENCE ❑SURFACE ®WELL or ❑SPRING ❑PURCHASED or❑COMBINATION WELL FIELD INTERTIF, or OTHER Pp{IT TO (Pool 11 A* lWAed Zlp r d_ n . . l TC TYPE OF SAMPLE(elHck a I,,aw M dae eoaI~) El ROUTINE n WlFReMuel: Total Free) DRINKING WATER ❑Cbkln --- CIrWk treelmenl ❑Rearm ❑Unnamed IX 011w-____ ❑REPEAT SAMPLE pm— colitonn".ce W%l Sal Data ❑ up Z- RAW SOURCE WAITER $paeeeOm OTowcowcrm NEW CONSTRUCTION x REPAIRS ❑Fecal Cdilonn ❑OTHER(Speedy)_- __ REMARK$: $2e" 3 (LJAW USE ONLY)W WNIR10 WATER RESULTS ❑UNSATISFACTORY,Cohh.,m Weeent ❑SATISFACTORY REPEAT E_CON Cd,mYrs obexrn SAMPLES ❑ Preeenm ❑E.Cdi ebx+nm REOUI RED ❑Fecal prannt ❑Fecal meenl /n�OTHER LABORATORY REWULTW ORM L1 TOTAL COLIF /100 ml E.COLT[.�/100 ML --- FECAL C OLIFORM _ /10O rN PLATE COUNT_taAnt ANorH SAMPLE NOT ❑SwnPla too oldO BECAUSE:MAR 2 0 2T CenR lu l q SUTABL0�CAUSE ❑W"vW tone. CITY OF AE TNrc ❑Ineomdamat nn UTILITY RE ❑ SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS IAe NO 9 DOLT% / PATE.TWE RFCEIVED RFC b By 0 OArF REV( nw LRVUKAOIw .ues �� � . .1 j bO11 JIe W°FIEY Nn WATER SUPPLIER R COPY Laucks Testing Laboratories,Inc. 900 S.Marne: Seattle.WA 981)B WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY N Instructions am not followed,sample will be G Ivcted. DATE COLLECTED I IME,yOL ffAD COUNTY NAME MONtI. MY YEARL (L.- 13 C 1 ❑AM I]PM L 1 r^ TYRE OF SYSTEM IF PLIbUC SYSTEM.COMPLETE: . ® I . . .UNon WOW s IYNY W 1 waemal NAME OF SYSTEM �ru4LO M . v�mskcCt6CD TELEPNONENO. .0 �� f rat/7 DAY T f i8 3 3 �. ' EVEMN I 1 SANIP&POLLECTED aV(Nans) SYSTM OWNEPANM I . ,e, SOURCE TYPE Lj GROUND WATER UNDER SURFACt INFLUENCE [J StIgRFACOEE 5 WE F FlD[I SPRING [I(PURCHASED a❑Cw OTHER OMBINATION. SEND FA TO:17"Fw0 N a.A Lw and 24 Ctr �C n 1YPF OF SAMPLEt haok way one In tlM ouAlmn) ❑ROUTINE ❑(` NO WATER hW',,and(RePoual tutcl Fee) DRINIKctack trwtmant ❑Reared ❑Uninitiated o,Olba. REPEAT SAMPLE Previous cdnwn:presence Lab a ... ❑RAW SOURCE WATER Souna e Q m ❑T wCoklonn NEW CONSTRUCTION p REPAIRS ❑twat CoNlorm OTHER Mpecffly)— REArW(S: b 7D 3 WE ONLY)DRROLDIO WATER REWLlB 11 UNSATISFACTORY Culiforns pnsant I ❑SATISFACTORY REPEAT ❑E.Goa pawn ❑F. Cot,absent CoGlorms Wsent SAMPLES Fecal r Fecal absent REQUIRED _ [] {>maNt ❑ OTHER LABORATORY RESULTS TOTAL COLIFORM /100 ml E.COLT tl /t00 ML FECAL COUFORM /Iouft NT /MI _.._._ AHOT --- []SWPNroo�BECAUSE MAR 20 2 lc.,fllwntgmw�CAUSE ❑wrong contan , CITY OF REWOOTC 0 ftonplate form kMLITV SVSTFIF#u bM canon ❑—____-___ LJ Excess) & 'r SIM OF GREEN Y FOP E{h ANAlQ nI RBUt TS LAa NO.V pglTSl MTE.TINE RlCEIYEO RkI:FNEo By CJk►7L� � `i' ' � �' f ' MlE REromEo uttatAraN F WATERSUPPLIER COPY r IF• 3 jt > Laucks Testing Laboratories, Inc. 940 S.Harney Seance.WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIDNS ON UM OF GOLDENROD COPY N UIsETIP bOIW al0 not f0ft W.sample 10 be relsctW. DATE COLLECTED TIME OI.LECTED COUNTY NAME MONM DAY TYPE OF SYSTEM IF PUBLIC SYSTEM,COMPLETE: PUBLIC ❑INWDUAL 1,D.Na 7 / (; C GROUP UwwerA�+w<e A B NAME OF YSTEM P, I �J spicox TELEPHONE NO. 1 IG DAY EVENING( 1 81"COLLECTED BY.(Nane) SYgEMOWNE71r) t. //� 80URCE TYPE GROUND WATER UNDER 5URFArE INFLUENCE ❑MWACE [2 WELL a ❑SPRING ❑PURCHASED a❑COMMIMION q��oRr WELL FIELD rn. INTERTIE aOTNER • 1�1`r� ,r TYPE��O//F''SAMPLE(cM k mry ar in tlW aak, � ZUTNKNG IIN WATER ElCNprlotl KI IResmuel:__.Tael_Fr W ��RRIII chwk troalment ❑FOwW ❑Untreew a QIns,. [�REPEAT SAMPLE Provwue-11- n Provence Lab e Date .._( (_ ❑RAW SOURCE WATER Same a m ❑TDgI W41am Mrw CONSTRUCTION a REPAIRS ❑Fps CoWwm OTHER(SP")— _ _ NE MARKS __...— (LAS USE ONLY)DRINKING WATER RESULTS ❑UNSATISFACTORY C,1. "e SATISFACTORV REPEAT [][.Coli preEanl E.Cdi aEum T Golitortns absent SAMPLESREQUIRED ❑FecN prow' ❑Fecal e t — OTHER LABORATORY RESULTS TOTAL COLIFORM 1 00 ml —_—E.COLT "ti100 ML -- FECAL COLIFORM moo ml PLATE COUNT /ml REQUIRED SAMPLE NOT TESTED BECAUSE--`IEV EQe&UNSUITABLE BECAUSE: ❑Sample tar old ❑CunRnnt tPo'eKI ❑Wmrq cwtnwr MAR 2 0 2pr,1 ❑TNTC ❑IricaTlpNe tam CI7'y OF RENT ElTiN°i°`,me ❑.____...._ __ "t1TV SYSiEµ PU EAam d6brle SEE REVERSE SIDE OF GREEN GOPY FORE%PLANATION OF REl JLTS W ROD R DKaT/1 GATE.TIME RECFNED RECEIVED BY I r I?ATE REPORTED LAaDMTORI 1wIMM6 CGX ffi Wi I,FV u191 WAFER SUPPLIER COPY ' Loucks Testmg Laboratories,Inc. 940 S.Harney Seattle.WA wim WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION.READ INSTRUCTIONS ON RACK OF GOLDENROD COPY N 41Etruotlone an not followed "ObVb Will Da nlecEd. i DATE COLEC'.TED TIDE COLLETED COUNTY NAME MONTH / DqY vEAR �<Z:�V pAM ❑PM TYPE OF SYSTEM IF PUBLIC SYSTEM.COMPLETE: - i PUBLIC C ❑INDIVIDUAL L�. /' CMS GROLP (.)Iw.w aW nea.ea 17 OF SYSTEM t 1 l+l W4% y�11�1FBylIECfK1ECIW TELEPHONE NO 1 AY r I _X,c• �t:t f�./ T EVENING k S�LE COLLEC I tO BY INone) SYSTEM OWNENAI�(jR.:(None) I T A 1M n i SOURCE TYPE O WATER UNDER UURFACEINIFLUENCE ❑SURFACE 0 WELL a ❑SPRING ❑PURCHASED a p COABM/1TOE' WELL FIELD INTERTIE aOTHER m D iEPORT t0 Prht K nAdd pt rW 21 ��e) 1 Yrdf ,TYPE I W�SM�a�4n OF SAMPLEkhace wly one in vee column) ❑ROUTINE DRINKING WATER ❑Cnla"neted IReardual Total Feel Mack=G Ant ❑FRend ❑Unlroetetl a lNM -.-.. 1 J i'EPEAT SAMPLE _ Pnrvinua cddonn Provence Lab e ❑RAW SOURCE WATER Source e�..m ❑TOW Comm ®NEW CONSTRUCTION a REPAIRS Fwa Como, ❑OTI*RIBpegNl_._ (LAO USE ONLY)DRINKING WATER REWLTS —_-- ❑UNSATISFACTORY.Cdllame oroeenl _---_ ❑SATISFACTORY REPEAT LIE.CaI'a "I ❑E.Coh abem,l SAMPLES REQUIRED ❑Fxel pee_•t ❑Feral Atbenl OTHER LAaORATORY RESULTS TOTAL COLIFpPI A oo mlMm E COLI A 1100 Mi. FECAL COLIFORM__1100 ml PLATE COUNT M I ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTED BECAUSE RECEh�rJ4 /n jUITABLE BECAUSE: ❑Semole too old fl e"t growM ❑Wmrpconla q NLC ❑Incomplete tam m MAR I/�R L O /,Lj��+u,dd cuMure ❑-- -- - CITY OF RE�IV•e d'D^' SEE REVERSt!!LX or GREEN COPY FOR EXPLANATION OF RESULTS LAB HD 11 MITS, OATF.M1IAE RFCNVFO MCEI,wn Rv I <. DATE REI4Rno r enwwe ` '7 a1h 1e0Y1111V aY1 WATER SUPPLIER COPY Laucks Testing Laboratories, Inc. 940 S Harney Searle.WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION READ INSTRUCTIONS ON BACK OF GOLDENROD COPY 11 instructions am not followed,sample will be roiected. DATE COLLECTED TIME LECTEO COUNTY NAME MONTH DAY Oi SYSTEM IF PUBLIC SYSTEM,COMPLETE, . PUBLIC ❑INDMIXIAL I.D.iVo. r L CIRIAl\GROUP arvw mY,neamrel I �. � C � 18 NAME OF SYSTEM _ l SPECIFIC , WHERE SAMPLE COLaEC IED TELEPHONE NO OAY( i r EVENING I I ' SRMPIE COLLECTED BY IN") SYSTEM OwNEFVMGR.:(Plans) SOURCE IVPE GROUND WATER UNDER SURFACE INFLUENCE SURFACE ®WELL or ❑SPRING ❑PURCHASED or❑COMBMMTON WELL FIELD INTERTIE w0THMI S�HO REPORT TO'.(Rint Fy}I Nrru,Adteasa uld C /<1 •� .� TYPE OF SAMPLE(CA k only om In IN.colunnl Y/p—d/11OUTINE �klonnaIW(ReuomC Tna1 Fnwl INKING WATLR ❑ check lreatment U Filteree ❑Untrawled oroSNY____—.—_ ❑REPEAT SAMPLE -- PnVlWecplllornlpreeenptl Lee• ' Daft C]RAW SOURCE WATER Sourro s N3 m ❑Total CgKpn ��- CONSTRUCTION w REPAIRS ❑Facial CoWi OTHER(Spsotyl._________—. _ RF.MARK3: r"., (LAS USE ONLY)OI0=0 Valli aselp ❑UNSATISFACTORY Collbnm pwwlt ❑SATISFACTORY. CdAorme abeam %�PPLLES ❑E.C.I.geaerrt ❑E.coil abanl '.. REWIRED ❑Facal prevent ❑Fecal abwnt _ BOTHER LABO"RRAAT'ORV RESULTS _ TOTALCOLIFORM A/100nl E.DDL.1 /'1/10;ML FECAL COLIFORM )too m1 PLATE COUNT mi ANOTHER SAMPLE REOUIRED o p» S ° BEC B`CAMEIVE CohiO..h AUSE. ❑WroM coMMrw ❑ cen p aw pp MAR 2020 O non caanw ❑— CITY OF ❑EAmas aeon. SEE REVERSE SIDE OF REVERSE SIDE T�%fKANAnON OF RESULTS OF RESULTS LAS NO.P DIGITS) LATE TIME RL'OENED atcENm eY i III W OME IIFPORRO�. IIE1YMa OMNIeYaeY Aaa r OVATER SUPPLIER COPY r Laucks Testing Laboratories, Inc. 940 S Harney Seattle,WA 98108 WATER BACTERIOLOGICAL ANALYSIS SA PLE COLLECTION.READ INSTRUCTIONS ON RACK OF GOLDENROD COPY N Wakmdom am not FoRovred,aemple WIN be rejected. DATE COLECTED TIME COLLECTED COUNTY NAME FNDNre DAY VEAA �_:�� e' r]AM PIA �.ir7•: nTYPE OF SYSTEM W PUBLIC SYSTEM,DOMPLEIE: W PUBLIC ❑I �'! I C CIRGLF GROUP NAME OF SYSTEM i �, wTTaYEPFaN`E /,r [J . It �? --- r 1 EVENING SAMPLE COLLECTE,.� �2 ,D BY(Name) SYSTEM OWNER)%"t IN * SOURCE TYPE GROUND WATER UNDER SURFACE INFLI#NCE ❑SURFACE Q WE or WELL FIELD❑SPRING [IP PURCHASED a❑ HER COMBINATION 'NrERTIEO j SENRFIEPORT TO:4Iant Fya/NenR,AIYi ka ana Z!2!y k I # Jr K f� i n TY SAMPLE(check bnly one M eea ccAeret) ROUTINE hbnnal•d _ b ' INK C INKING WATER ❑ Ifle"a ,—TOW re_F Cnack heetm arI ❑F,N~ ❑REPEAT SAMPLE ❑Untreated a omer_ e _ Pnvrcus cdllorm Presence Labs -_ \ Date ❑RAW SOURCE WATER Source a ❑Teal Ccalonn _U'NkyN CONSTRUCTION a REM1w ❑F•cFecalColtkoMon mn ❑OTHER ISw,Y, (_ v L REMARKS. LAO USE ONt.YI T WATIN RESULTS I ❑UNSATISFACTORv.Cellam•pr•s•rd ❑SACoTISFA•TORV. REPEAT ❑E.CCk spent ❑E.Cdi abeMl aboare SAMPLES Fecal REWIRED ❑ bnase Face!abeent OTHO LANDRATORY ftEsMT$ TOTAL COLPORMt A npD ntl -- "Too ML FECAL COUFORM_rypp ml Me ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTED BECAUSE MAR 2 JS?q% UITABLE BECAUSE ❑sample too okl CITY OF IW.Ah ❑W,"container UTILITY S�, ❑Iboornows torn ❑Turbat Culture ❑_____.__. . ❑Eacep oebas Al"r-QFr�p ' d COPY FOR FIlPLAFI LpI1arGem Tew FOORNEDFp LAGOAAI rewwa me.saenev wn WATER SUPPLIER COPY L.aucks Testing Laboratories, Inc. 940 S.Harney Seattle,WA 98108 I WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY It instructions are not followed,sample WIN be rejected. DATE COLLECTED TNAE COLI ECTED COUNTY NAM! n Y rADNT14 DAY YPAR h I s k/ � `)/ ❑AM f�pN yr C Ilk, `S TYPE OF SYSTEM IF PUBLIC SYSTEM.COMPLETE: If s Q PUBLIC ❑INDINDl1AL 7 tr C�iir A 8 NAME OF SYSTEM YiNK;LOG N WHERE SAMPLE COLLECTED TELEPHONE NO. _— DAY EVENING SAMMLC.OLLECTED BY.(Nall SYSTEM OVMEWDIQR.:(Norm) r e SOURCE TYPE GROUND WATER UNOER NIFLIlE16E N❑SURFACE WELL or ❑SPRING ❑PURCHASED or❑COMBINATION WELL FIELD 1NTERTIE or OTHER e SEND REPORT TO,(Prno Fun Nary.Addr wa ano Zip Cool -- 1g. rrs.nr T n / TYPE Ot SAMPLE icM k only one M Ms column) ROUTINE []Cbl...It IReaqual Total Free) DRINKING WATFR - cb k troetrmnt F,nwed ❑Untraaw or OtMr REFEAT SAMPLE Pmvmos Ca 00nr Presence Labe Date �]RAW SOURCE WATER Spume a a ❑Total CDI11Prr11 Q NEW CONSTRUCTION W REPAIRS ❑Fe"CdIb,, ❑OTHER ISpoedy) Al (LAB USE ONLY)ORNOWN WATOt RNMR.TS s ❑UNSATISFACTORY CoMhrms p featlt SATISFACTORY. CWrAxms aDaMn REPEAT ❑E.Cok preserR ❑E.Cok anawR SAMPLES ecal Present W.Mob N REQUIRED �F ❑F OTHaR UBORATM ItNitIll TOTAL COLIFORM___/100 Mk_ E,COLI-__ rt W ML FECAL COLIFORM-__/IOD M PATE COUNT mi ANOTHER IUMPLE REOUIREO - - SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BFCAU%, ❑sornpw too dtl ❑CmAuent 9NwM ❑Wrorq container ❑TNTC mplate torn❑Inco ❑Turbid Cullum ❑ _. ._.. _. ❑Eacese deMo SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION Of 11"UV 5 LAS NO ITDIGITS) DATE.Tom oltcm 0 RFcnnonr WERE L*AKM� WATER SUPPLIER COPY Loucks Testing Laboratories,Inc. r 940 S.Harney Searle,WA 98108 A WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD CAM N MEtrucdava are,not IpltoweU,t1a111pb WK be ralecte0. DATE COLLECTED TIME COLLECTED O UHTY NAME MONTH my YEAR �. 00 __ TYPE OF SYSTEM I IF PUBLIC SYSTEM.COLIPLETE: r ®PUBLIC Q INDIVIDUAL NAME OF SYSTEM I ^C) / SPECIFIC L WIIiREWAKE COUEc ED TELEPHONE N0. _ y ; 7•' EVENING SAMPLE COLLECTED BY;(Nantt) SYSTEM OWNERIM .:�Pa) T 01 _.SOURCE TYPEET��Lj GROUND WATER UNDER SURFACE INFLUENCE ❑*URFACE W WELL w WELL FOLD❑SPRING Q PURCHASED or❑COMBINATION 5F,ND REPORT TO:T F W FIe,F� uq 2Wyotl�) u� / T AFC S TYPE OF SAMPLE IMeck d%y eM In Oft cderrrnl ❑ROUTINE DRINKING WATER ❑CNonnatel(Rpwual Total Feel clwGk treatment ❑FieereU ❑Gntrmted W Ot11M ❑REPEAT SAMPLE PreII"ll cd-w PrWanoe Lab a Date ❑RAW SOURCE WATER Source a I—I ❑Total Cw,,,rn ^' NEW CONSTRUCTION ar REPAIRS Fecal Cdltorm ❑OTHER(SP.,fy) REMARKS: (LAB USE ONLY)DRINKING WATIER RESULTS Q UNSATISFACTORY Cdrbrme Prleant ❑SATISFArMW.. C�tamM absent a REPEAT ❑E.Coo OraaNil ❑E Cdi aMant SAMPUEQUIFF' Facer t Fecal abwl REOUIfFO U Preen ❑ OTHBR LNORAT'ORY RESULTS I TOTAL COLIFORMA /10D m1 E.CULT A1100 ML FECAL COLIFORM 1100 mI ' �nnr�yB 1 _. UrrH _.AN07HER G SAMPLE NOT TESTED BECAUSE MAR 2 ABLE BECAUSE ❑SW"CmIa r CITY OF R ,[]lnc0mPw8 Mtm UTILITY SY culbae j] _ ❑Ellbaea pabrN 1 a.~aSEE R VlR !SIOE OF GREEN COPY FOR EXPLANATION OF RESULTS Im D P OID11% parr.Fall!RECENED 11ECEMD BY O�,I/I/5Ili ' f ',,kI )-AREPORTED LIAORVORY • F ,, WATER SUPPLIER COPY Loucks Testing Laboratories,Inc. 940 S.Harney Seaffle,WA 9Bt OB WATER BACTERIOLOGICAL ANALYSIS SAME CDLLECTION.READ INSTMrnONS ON BACK OF GOLDENROD COPY N instructions are not followed.sample Wit.be rejected. DATE COLLECTED TIMEFOILECJED COUNTYW9E MONfM DAY vEV1 2�C �`11 Z 1 ®AM ❑PM '< I N O grPE OF SYSTEM IF PE F PL1BlIC SYSTEM.COMPLETE IN-MDUAL ).D.No. 7 1 b r O C A 8 NNr..o,:,a neY.ca NAME OF SYSTEM /p ! i LL��TUB 1YFIFIE SIMPLE COLLECTED TELEPlIONE NO. Y. DAY 7,(1 EYENIND 9VAP�yE.COU.ECTED W.ON") SYSTEM /M i SOURCE TYPE GROUND WATER UNDER SUREMA INFLUENCE ❑SURFACE ®WELL or ❑SPRING ❑PURCHASED or❑COMBINATION WELL FIELD INTERTIE MOTHER SEND � r. WFuNwrAD O p Codrl h d Zle K.(r lt�:Y1a . rI r I YPE OF SAMPI-I IWMWk only onE M VIEW collalel) HOUIINE DRINKING WATER ❑CnbnnetW 1ReveluaE_Tone Fee) dw:k tw~t ❑Flawed ❑untn w a Other_ REPEAT SAMPLE Prwroue WOklwm weewlCe Lao a____,^_ Dote ..__/`—_/—'_ ❑RAW SOURCE WATER Source a m (]Total Coilom ®NEW CONSTRUCTION I REPAIRS ❑Feat Cos/mm ❑OTHER(SPedtr)-..p �1 x._ . _. _.__._. RE MAIM. � BAD WE ONLY)DR MKNIB WATN1 RNRILTO UNSATISFACTORY.COYIORne Patent ❑SATISFACTORY CotbrerM oDMrt REPEAT ❑E.Cok lar'emt ❑E.CWI aWwnt RE SAMPLE D ❑Foal Pea" ❑FEEI MMent 'OTHER LABORATOFIY RESULTS TOTAL CaIFORM (ail IXl mi L COLT /l O0 ML FECAL COLIFORM___/100 ml PLATE COUNT ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTED BECAUSE TE aGM ❑Sample too oM ❑Con%o nt wow ❑Wrwp cm—w 12 2001 ❑IrwonlpNte townLJTUIW CW VIa • ❑_ EpjX4g NTON LITELITY SYSTEMS SEE REVERS[ SIDE of GREEN COPY FOR EXPLANATION OF RE SUO S W No R DlMisl MIT.TNAE RECENED DATE nEPORtFO LABOMYOW 1 7 1 RRAYMa Re.MEE '. WATER SUPPLIER CCIFY Laucks Testing Laboratories,Inc. 940S Harney Seattle WA98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY If instructions are not followed,sample will be rejected. DATE COLLECTED TIME COLLE110 COUNTY NAME t.IpRR IOW YEAR _: �'•. L i ❑AM 7. PM /1 OF SYSTEM IF PUBl1C SYSTEM.COMPLETE: PUBLIC ❑INDIVIIXIAL LD. `AGROP Irv]IN r i]W J1 NAME OF SYSTEM AA EO el SoCCIFq LNIHIE SMILE COU6CIB/ TEIEPNOPIE N0. ' C-•.I /;.'/ DAY _ %4 It .. i '1u 51...LL I EVENING * SA LECTEO BY.(N.) SYSTEM (NFmsI r Itk� RCE TYPE LGROUND WATER UNDER SURFAroE INFLUENCE `I SURFACE CR WELL or ❑SPRING ❑PURCHASED or❑COMBINATION WELL FIELD IHTERDE or OTHER WAB MILL TV T OF SAMPLE IHIeCA a"0a,in tllls ookam) ❑ROUTINE DRINKING WATER Dnior,.ow vwrid.al. Total �I check troetment Cl. Filtered Unima d W Other __... [J REPEAT SAMPLE P.gas oauorm pn.rlo. LAB a_.__ _ R, V SOURCE WATER Source e O m n TOW CoMpm [�NEW CONSTRUCTION or REPAIRS rLsJ,FeoY canpm ❑OTHER(Swill) REMARKS: (LAB USE ONLY)DRINKING WATER RESULTS lb UN:ATISFACTORY Cohk+rms Pneent FL'aATISFACTORY AFPEAI ❑E.W'present ❑E ca'absentldo me abeamSAMPLES REOUIRED ❑Fecalresent ❑Facet absent e OTHER UBORATORY RE&1LTS TOTAL COLIFORM ;100 ml L.GOt I ILL ML FECAL COLIFORM /100ml PLATE COUNT I., ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTED BECAUSE REM07E BECAUSE' ❑Sample too am ` lJ 1powth ❑Wrorp ca to lO un ����FMATLTpp�����• ❑ZinipMe lam NOV 1 g E1AEEf cua„•e ❑ ------- CITY OFq&ftr" i lit suk IAs No PDorsl Mat.TIME RECtNFD RFDENTD nv llrl of r TMTE IIEPFW rFD IAEpRUQR1! � x 1�e IMATE R SUPPLIER WATEPPLIER COPY Laucks Testing Laboratories,Inc. 940 S.Harney Seattle,WA 981p8 WATER BACTERIOLOGICAL ANALYSIS SAAMIE COLIECRON:READ NISTRl1CT10NS ON BACK OF GOLDENROD COPY N N1eLelDUona w not Wowed,"MPN will he rejected. DATE COLLECTED TR.E C04ECTED COUNTY NAME MINIM DAY YFM Tel / // 7 o, ❑AM ®PM K 1 ✓ TYPE OF SYSTEM IF PIlB1.IC SYSTEM.COMPLETE: PUBLIC i ❑INDIVIDUAL I.D.Ns. / I r S Q C , A 1 wwe a y 1 neawicn V'/ NAME OF SYSTEM 61 011 T L —7gNVAE,gE SAMPLE COUECTFp TELEPHONE ND. X . n! � / ' 1. DAY�� EVENING _i_ , Sllli LLECTED BY Twill srj FEM OWNER/MOR. 1 /I Y�� ✓ � SOURCE TYPE GROUND WATER UNDER SURFACE 110LUENCE SURFACE ®WELL M ❑SPRING []PURCHASED M❑COMBINATION WELL FIELD INTERTIE M OTHER r c 6,nd., WAY1ihi ', TVPL OF SAMPLE(c{yaK W*,,W M this oabnw) L� ROUTINE ❑ DRINKING WATER Chbnnated lPesqus Total Fecal clwk 1WMtment fiaMeo C�UntmatMl M OIhM . I] REPEAT SIMPLE �+J Provious Mli'M pmsnnco Lab a Date __/-_,_/_— �l�W �1 �]RAW SOURCE WATER Scoroe e m ❑Total [j NEW CONSTRUCTION or REPAIRS Facal ColAeml ❑OTHER Swc,hl - I REIMRK$: "Ill USE ONLY DRNREeq WATER MVATS f ❑u4SATISFACTORV Coblorme pa,,ol E2UTISFACTOW/, i REPEAT ❑E.Cat IKeeent []E.Coo aeeenl ComonM aWent SAMLES REQUIRED ❑hcal Mw nl ❑Fecal atnant OTHER LABORATORY RswLn TOTAL COLIFORM—/100 ml E COLI /100 ML FECAL COLIFORM—/100 ml ANOTHERSAMPU`jft SAMPLE NOT TESTED BECAUSE- e,TS�SNII �BECAUSE❑Sa,lple too nM ConAwhl 7oYvlh ❑wrap costa~ Ol*-jo gENTON ❑kKomPMe form U I�J-1B6w§mS PY"1 1 KPLAIADIN gL RESULTI LAN ND.R DIWISI DATE,IMME IIECFn Pf.CENED eV DATE 1a:geiED lAK1MTOhv' i ao,I:a F oaeae aa•wev.+n ' WATEV SUPPLIER COPY Laucks Testing Laboratories,Inc. 940 S.Harney Seattle WA 98TOB WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK DE GOLDENROD COPY B instrucbons am not followed,aM F will be rejected. DATE COLLECTED TIME COLLECTED-/ COUNTY NAME -� MONTH pAY yEI.R /1 [DAM ®P kfe. T'PE OE SYSTEM IF PUBLIC SYSTEM.COMPLETE; -- f31PUBLIC ' cIyao� -❑INDIVIDl1AL LD.No. I 5 cQAA ae w NAME fSYSTFM 1 WIERESWKEWII.ECTED TELEW4ONE NO. Oa) U re"S1' b DAY S©A�1 I0 t EVEN.W 1 SM� OLLECTED PM.(N,,* S OWNEP/MOR. INam•I C let _ �UKW,E"TYPEr� GROUND WATER UNDER SURFA INFLUENCE RFCE c5 WELL or ❑SPRING ❑PURCHASED w❑COMBINATION WELL FIELD INTERTIE orOTHER sPf T ro IvrlmFFy1N. Amlw ana z °y�1 C, TYPE OF SAMPLE(papa aMr pM ti INe miwaa,) ❑ROUTINE Nwmat•d lHealauel io10 DRINKING WATER C ❑ .Neck eptment ❑Filter. - ❑Untnow or Doe, ❑REPEAT SAMPLE pmw cM,twm PraaenM Labe__ ._ DaM._/__/_ ,o ❑RAW SOURCE WATER Soutca e m �7py Caabttn NEW CONSTRUCTION W REPAIRS ❑Pape comewn ❑OTHER(Speedy) _ (AS USE ONLY)DRINKING WATER RESULTS UNSATISFACTORY CoMlorme pIa•ant--- ❑'SATEICOMOMatATalit REPEAT ❑E.Cok pteeanl ❑E.Coll absent SAMPLES REQUIRED ❑Fecal p eeent ❑Fecal absent OT1eI11 LAIORAIVIV RESULTS TOTAL COLIFORIM _.no0 m1 E.COU T/100 ML FECAL COUFORM _/Too ml PLATE COUNT Intl ANOTHE SAMPLE NOT TESTED BECAUSE. NOV 1 yI T}CSU1TABLE BECA,ISF ❑Sample too MM a7Ci7Ytco^Kua,tgrowtn ❑v"praa no, ❑k aenpMM TC Emn CITY OFSRE ITUTILY yS❑-_._-- ne cW1uro dobne SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION Of RESULTS W ND.P lMKly DATE.TIME PECENEDRECENFO Pv / r GATE MPp1iF0 LABdM1T111y aweAaa .OF1M ae FRY elfr WATER SUPPLIER COPY ' 1 Laucks Testing I-BbOratoriss,Inc. 940 S.Hamey Seattle.WA 98108 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION.READ INSTRUCTIONS ON BACK OF WXL,Z W COPY N Lnetructio o ere not Tolloweq Nr.Yi IM W Aleotaa. DATE GOLLECTT-0 TMeE CDLLECTED COUNTY NAME a1DNrN If OAY YEAS / : [j / 1 u, CAM toPM (11F�a TYPE OF SYSTEM W PIISEIC SYSTEM,CDMIE:�' . 90PUBLIC R.E' ZD INDIVIDUAL I, / C ALE aB P IN�e0yli0y,rap `1! NAME OF YSTEM r .-t (.- /t - - SPECbTC LOCAnON VIHERE WIRE COLLECTED TSLEPIp&No �— iU"FACE GAY EVELECTED SY:It'1•nnl SYSTEM OWNER/MGR. ITtemeI E GROUND WATER UNDER SURF EINFLUENCE ❑WELL FIELD❑WELL w SPR14G ❑PURCHASED,❑COMSMAMON PNTERTIE w OTHER • ' SEA NEP'ORT T- O;LP-1 Fyll Neme.Atltlrenq,erq Z-P Code) f_. . ��waw�wIav TYPE OF SAMPLEW—k pulp err IN bla aelw ) ❑ROUTINE DRINKING WATER ❑Chl—n Wed lR"0U.t L^tal I F.ep1 check Inrmenl ❑Fote ❑REPEAT SAMPLE Pmiwls cdnorm Pnarlce LSD Data ❑RAW SOURCE WATER Source a❑$ ITI�I-W ❑Total Carwm NEW CONSTRUCTION w REPAIRS ❑Fe CPbIo^m NOTHER(SP y)___ %MUiKS'. 7-7 naNa WAY"RssLUTs UNSATISFACe ❑SATISFACTORY, REPEAT ee E.Cobbant Coklwma AOeent SAMPLES REGUIREO Feal obard OTHER LABORATORY lepATS TOTAL COUPORM,__../100 ml /ice ML FECAL COLIFORM__/10o ml ANOTHER SAMPLE REOUPEO SAMPLE NOT TESTED BECAUSE. tj r4 FIEGUSE, ❑SWIQI!LOP am ❑Wmrp amamer CITY UTILI� ❑1^cwnPiale iwm ❑Tarbid a,AMe ❑_..._-._. _ ❑F.a debts SEE REVERSE SIDE OF GREEN COPY FOn EkoLANAY—OF RESULTS UlAlw nOpRS DATE,TMIE RL--- RECENEDeY fir/ 1 MTE REP mo -..- UeOAATORY I DcHwoe aP,1W Opt RV M WATER SUPPLIER COPY t Latwks Testing Laboratories,Inc. 940 S.Hwn y Seattle,WA 98108 I WATER BACTERIOLOGICAL ANALYSIS SIMPLE COLLECTION:READ INSTPUCIIONS ON BACK 01 dd4 0ENR00 td)PY R MIERtFelon are not foamed,tlanlDN WIN IN rejected. ESY"STEM TIMF•POLLEGTED COUNTY NAME tx1R QAM ❑PMI ItTRY PUBLIC SYSTEM,COMPLETE.W I.O. . ' �. ` 1'14OROVP A ' NAME OF SYSTEM / n 1S7PR7FtCLOCATION tRIFIF TTIEPIONE Nq. t j Olil CT LU a�v_S7fl41 i ;,P S 3 i . I.r t rr, t•tctsr 7...j. t' ' Ser,fi+l:s• >• EVENING SAMP COLLECTED W.teeth) S OWNER•AMiR. ( 1 y ma/#I 't..t J/•//f SOURCE TYPE�n GROUND WATER UNDER INFLUENCE . ❑SURFACE IN WELL or WELL FIELD[I SPRING [-I PURCHAINTERTIESEDOr❑COMBINATION w OTHER SFrREPORT TO: FUN Nwu,AOOw rM 2p Godlp � :It t•d ,- A FL FCH 'lie S.- TYPE OF SAMPLE IoMch omy one In mts column) ❑ROUTINE ❑ChlamNed(RWQM:_TOMS Fwy DRINKING WATER YT�,R.}t cOsck VMtmant ❑U ❑lMtmtetl y I REPEAT SAMPLE P —_ nTR1 — wvaue colRwm pmaenca N Leb LWL Data GTY OF RENTON )T'Y SYSTEMS RAW SOURCE WATER Sou,ceN J Total CdIMnI NEW CONSTRUCTKNV R f FfIRS �'4 Q Fecal Cdito m ❑OTHER(SPeoay) _ ._....- REMARKS'. .A. s tl-AB USE ONLY)DR"UNG WATER rAOMLTS L j UNSATISFACTORY.Cotft preaenl SATISFACTORY, oMkmla apaaM REPEAT ❑E.CdI aSAMPLES een,t ❑E.Cd�W MtR WOUIREO ❑Fecal taeeent ❑faal ab6em OTHER LABORATORY RBWATS _ TOTAL COLIFORM_/100m1 E COLI_-,,n00 ML — FECAL COLIFORM_/100 ml PLATE COUNT 1m1 ANOTHER SAMPLE REWIRED SAMPLE NOT TESTED BECAUSE TEST UNSUITABLE BECAUSE'. ❑Sande too dd ❑Conflw t gmwth ❑Wrmq cm,ta,w, ❑TNTC ❑IxompHte tam ❑Twdo Cows ❑ ❑Excess doom SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS ue NO,nKPTsI o MTF.TIMEaEcervEo RECENro Sri r MTE D usDRAr N.t . 077 t .1maaINIY W, WATER SUPPLIER COPY FAX NO. 2908431 P. 02/02 i--� Lauck3 Testing Laboratories,Inc. l 940 S.HWney Surtle.WA 9Bt08 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION:READ INSTRUCTIONS ON BACK OF GOLDENROD COPY It instructions )ft net/0110 W W,Lmple Wtll he rejected. DATE COLLECTED TMAE COLL COUNTY NAME 40MN DAY vEAA C : O/ //e, /o/ ❑AM �ECTPMPASAG TYPE OF SYSTEM IF PUBLIC SYSTEM.COMPLETE; PUBLIC Cj INDIVIDUAL mI• N0. G/per,L�GRCUP Irn+aaMrrwbns+l � MANE Of SYSTEM aT �^ �•! fer"PrA YAIEREwyt ED Eomiw TELEP40NE NO. V // r<'r r,0FKS3zr * d u f Oa EVENING t1 $A`��LJiGB[LECTED Nams1 SYSTLM OWNE"(1i .:INpmml iG SOURCE`V/E GROUND WATER VNOERSUPrA INFLUENCC ❑rySVRFPApCE RWgi—FIELD❑SPRING O NttflT SEO w❑a OTHER • $EFCi[KN'_•O:,�pnwt ntfuu NS 6 yn.,Ay�saa,tr�pCoaF) IF TYPE OF SAMPLE(aNFFA eery ans In Ilia mlumnl ❑ROLTNE CFlo�netad IP ndur, •prm DRINKING WATER From)❑ ohwk beatmmnt ❑Formed W�Ob ❑unl�iaR m Omar_,_• _ ❑REPEAT SAMPLE Pr Ca410m1pemMcm Laol _ Date ❑PAW SOURCE WATER Sauxe o Es] m C]Tots C.I.fa m NEW CONSTRUCTION or REPAID$ Fwal Celllprrn REMARKS' (LAB USE ONLY)OIUNKINO WATER RESULTS ❑UNSATISFACTORY•CFLMrmS pm,.t SATISFACTORY, REPEATCa roll.md.mnt AMPLE ❑F.Cal,p,m�; ❑E.Lau eoamnt OU PE ❑Fxv pe.e.t ❑Fpeal aewm OTHER LABORATORY RESULTS TOTAL COUFORM__nOD ml E.COLT_1100 ML FECAL CO.IFOAM—n00 m1 PLATE COUNT_Jell ANOTHER SAMPLE REQUIRED SAMPLE NOT TESTEO BECAUSE: TEST UNSUITABLE BECAUSE ❑SJmpa tea a C ConRumm gmw ❑Wrom ca,uzpM TNTC �ImcoAtplmlm to" ❑bma etrmN .__ EAeEy amp" SEE REVERSE 3-DE OF GREEN COPY FOR EXPLANATION OF RESULTS W NO.pow•s, OM[.YeE AF.CDvED NlCNVFJ ev 0?1711 pat[A[mc '( LA10RATCAY I yal F i OPryP l�N OM AM1 umn ShortPlat'(SHPL-#* ) REQUEST FOR PROTECT N Prvlim Plat (PP#----. ) CAG# To: Technical Services Date o vi Zvtso W0k Green# From: Plan Revicw/Project Manager Project Name _ sovs-KWy-r (70 cha.-+acn Description of Project: _LiATs2 Slau�g3—rl a MI S'Mf? onv t sv__Fey 2, ��13�b'VKwOK�21-T' CSF SF}u FFlsTb Q SkrV Circle Size of Waterline: 10" 12" Circle One: New or Extension Circle Size of Sewerline: 0 10" 12" Circle One: New or Extension Circle Size of Stormline: 15" 18" 24" Circle One: New or Extension Addressor Street Namc(s) - Dvlpr/Contractor/Owner/Cnslr.: 156cp 'pryC%-0 (70 cAanttcn tnu) Check each discipline involved in Project Ltr Drwg #of sheets per discipline ✓ ✓ C9' Trans-Storm _ W ❑ (Road.ayrJtaina[c) (Off ti�'vnpn.-crtrnuxindvdc bin none) (include TFSC theca) QK Transportation (Stgm%ua on,Q�nnc'iudoo,Ughdng) Gr ❑ fK Wastewater (ir ❑ S miwy se.0 Main Qndvdc Win name) (v Water (i.laiiu,Va)vu,Hydran�) W ❑ // stlderf ,./../ Qnetade eempotlm L Nonwnw CO slmeu) l Su face Water ❑ tfnprovements — (CEP )('no.dc bssln nu c) ------------ TS Use Only TG�-40-An 9- - !Tc rKlo-G!- as$a Tr= ag$�