HomeMy WebLinkAboutAirport-lift-station-water relocation 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:
08/26/2014 Collected AM
Month Day Year 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-AIRPORT LIFT STATION
Contact Person: ABDOUL GAFOUR/PAT MILLER
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/PAT MILLER
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected by (name): PAT MILLER(W3625)
Specific location where sample collected:
W3625 SOUTH END OF PIPE
Special Instructions or Comments:
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 /100 ml. Fecal Coliform /100 ml.
Method Code:Date Received:
8/26/2014
Date Analyzed: 8/26/2014, 12:00 Date Reported: 8/27/14
06604901
Sample Number (DOH number plus five digits)
Lab Use Only:
DOH Form #331-319 (revised 8/05)