HomeMy WebLinkAbout2 satisfactory lab results - Forest Terrace W-4048 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:
05/12/2021 Collected � AM
Month Day Year 10:10 � 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 W ater Facilities Inventory (WFI):
ID# 71850L
System Name: FORREST TERRACE
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
SAMPLE INFORMATION
Sample collected by (name): BRAD STOCCO
Specific location where sample collected:
HYDRANT
Project Name or Comments: W-4048
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: 5/12/2021
Date Analyzed: 5/12/2021, 14:00 Date Reported: 5/13/21
066-02769
Sample Number (DOH number plus five digits)
Lab Use Only:
DOH Form #331-319 (revised 02/16)
5/13/21 E-mailed to:
W-4048 Forrest Terrace
Union Ave NE and NE 27th Street
Brad Stocco
Gregg Seegmiller
Justin Johnson
Michael Sippo
Emina Sulych
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:
05/12/2021 Collected � AM
Month Day Year 10:25 � 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 W ater Facilities Inventory (WFI):
ID# 71850L
System Name: FORREST TERRACE
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
SAMPLE INFORMATION
Sample collected by (name): BRAD STOCCO
Specific location where sample collected:
HYDRANT
Project Name or Comments: W-4048
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: 5/12/2021
Date Analyzed: 5/12/2021, 14:00 Date Reported: 5/13/21
066-02768
Sample Number (DOH number plus five digits)
Lab Use Only:
DOH Form #331-319 (revised 02/16)
5/13/21 E-mailed to:
W-4048 Forrest Terrace
Union Ave NE and NE 27th Street
Brad Stocco
Gregg Seegmiller
Justin Johnson
Michael Sippo
Emina Sulych