HomeMy WebLinkAbout17-M007442.pdf AmTest Laboratories
13600 NE 126th PL STE C, Kirkland, WA 98034
425-885-1664 www.amtestlab.com
COLIFORM BACTERIA ANALYSIS
Date Sample Collected Time Sample County:
11/10/2017 Collected AM
Month Day Year 11:05 PM KING
Type of Water System (check only one box)
Group A Public
Group B Public
Private Household
Other: __________________
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
ID# 71850L
System Name: CITY OF RENTON
Contact Person: ABDOUL GAFOUR
Day Phone: 425 430 7210 Cell Phone:
Eve. Phone: FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOUL GAFOUR
1055 S GRADY WAY
RENTON, WA, 98057
Data Delivery: MAIL EMAIL:
SAMPLE INFORMATION
Sample collected by (name): BRAD STOCCO
Specific location where sample collected:
SUNSET COURT APTS E STAND PIPE
Special Instructions or Comments: W-394401
Type of Sample (must check only one box of #1 through #4 listed below)
1. Routine Distribution Sample
Chlorinated: Yes No
Chlorine Residual: Total____ Free____
2. Repeat Sample (after unsat. routine)
Distribution System
Source Groundwater Rule (GWR)
(Population of 1,000 or less)
3. Raw Water Source Sample
E. coli - GWR source sample
Fecal - Surface, GWI, some springs
Other
|__S__|_____|_____|
Public Systems must provide Source Number from (WFI)
Unsatisfactory routine lab number:
____ ____ ____ ____ ____ ____ ____ ____
Unsatisfactory routine collect date:
________/________/________
Chlorinated: Yes_______ No_______
Chlorine Resid: Total_______ Free_______
4. Sample Collected for Information Only
Construction Repairs Private Residence Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
Unsatisfactory
Total Coliform Present and
Satisfactory
E. coli present E. coli absent
Fecal coliform present Fecal coliform absent
Replacement Sample Required
Sample not tested because
Sample too old (>30 hours)
Improper Container
____________________________
Test unsuitable because:
TNTC
Turbid Culture
____________________________
Bacterial Density Results: Plate Count / ml. E.coli /100 ml.
Total Coliform < 1 /100 ml. Fecal Coliform /100 ml.
Method Code: SM 9222B Date Received: 11/10/2017
Date Analyzed: 11/10/2017, 15:00 Date Reported: 11/11/17
06607442
Sample Number (DOH number plus five digits)
Lab Use Only:
DOH Form #331-319 (revised 02/16)