HomeMy WebLinkAbout19-M002982.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:
05/30/2019 Collected AM
Month Day Year 11:00 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: FINEY SHORT PLAT U-16005573
Contact Person: ABDOUL GAFOUR
Day Phone: 425 430 7210 Cell Phone: 425 282 2373
Eve. Phone: FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON
ABDOUL GAFOUR
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected by (name): BRAD STOCCO
Specific location where sample collected:
HYDRANT
Project Name or Comments: W-3915
Type of Sample (select only one type of sample from types 1 through 5 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. Ground Water Rule Source Sample
|__S__|_____|_____|
Triggered (A/P)
Assessment (A/P)
Unsatisfactory routine lab number:
____ ____ ____ ____ ____ ____ ____ ____
Unsatisfactory routine collect date:
________/________/________
Chlorinated: Yes_______ No_______
Chlorine Resid: Total______ Free_______
4. Surface or GWI Raw Water Sample (Enumeration)
E. coli Fecal Filtered Yes___ No___ |__S__|_____|_____|
5. 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
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 /100 ml. Fecal Coliform /100 ml.
Method Code:SM 9223B Date Received: 5/30/2019
Date Analyzed: 5/30/2019, 13:45 Date Reported: 5/31/19
066-02982
Sample Number (DOH number plus five digits)
Lab Use Only:
DOH Form #331-319 (revised 02/16)
Finley Short Plat - W 3915
2525 Aberdeen Ave NE
U16005573- WTR27-03915
E-MAILED ON 6/5/19
TO:
Brad Stocco, Gregg Seegmiller, Emina,
Andrew, Justin Johnson