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AmTestr� Laboratories <br /> abo atones <br /> 13600 NE 126th PL STE C,Kirkland,WA 98034 <br /> 425 885-1664 mw+w.amtestlab:com <br /> COLIFORM BACTERIA ANALYSIS <br /> Date Sample Collected Time Sample County: <br /> 06/19/2015 Collected 13 AM <br /> Month Day Year 12:30 E1PM KING <br /> Type of Water System(check only one box) <br /> ❑Group A Public 0 Private Household <br /> ❑Group B Public 0 Other: <br /> Group A and Group B Systems Provide:fronrWater Facilities Inventory(WFI)• <br /> ID#N/A <br /> _System Name: <br /> Contact Person:CHRIS WILLIAMSON <br /> Day Phone: Cell Phone: 425.864 5645 <br /> Eve,Phone: FAX: <br /> Send results to:(Print full name,address and zip code) <br /> HOS BROS CONSTRUCTION,INC40 <br /> CHRIS WILLIAMSON <br /> PO BOX 1788 <br /> W00DINVILLE,WA,98072-1788 <br /> SAMPLE INFORMATION <br /> Sample collected by(name): <br /> Specific location where sample collected: <br /> 4 CONN E OF 40-60 TO BO S OF 40 60 (I, .: '4/11 C&Ifie tes+1) <br /> Special Instructions or Comments: BOEING EVERETT .•• <br /> Type of Sample(must check only one box of#1 through#4 hated below) <br /> 1.0 Routine.Distribution Sample 2.q:Repeat Sample(after unsat,routine); <br /> ❑ Distribution System <br /> Chlorinated:]Yes 0 No 0 iSource Groundwater Rule(GWR),' <br /> Chlorine Residual:Total_Free (Population of 1,000 or less) <br /> 3,Raw Water Source Sample <br /> LI E.col:•GWR'source sample Unsatisfactory routine lab number: <br /> 0 Fecal-Surface,GWI,some springs <br /> ❑Other <br /> Unsatisfactory routine collect date: • <br /> 1—S—I —I / / <br /> Public Systems must provide Source Not.-from hVFl) Chlorinated:Yes Na. <br /> Chlorine Resid:Total Free <br /> 4.0 Sample Collected for Information Only <br /> 0 Construction ❑Repairs ❑Private Residence 0 Other • <br /> LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY, <br /> o Unsatisfactory 0 Satisfactory <br /> Total Conform Present and <br /> ❑E.coil present 0 E.cols absent <br /> O Fecal colitermpresent 0 Fecal coliform absent <br /> 0 Replacement Sample Required <br /> Sample not tested because Test unsuitable because:' <br /> ❑Sample too old(>30 hours) 0 TNTC <br /> ❑Improper Container 0 Turbid Culture <br /> 0- ❑ <br /> Bacterial Density Results:Plate Count /mli E.col /100 mt. <br /> TotalCaliform /100 ml: Fecal Coliform /100'ml, <br /> Method Code: Date Received: <br /> 6/19/2015 <br /> Date Analyzed:.6/19/2015,i4:15: Data Reported: 6/20/15 <br /> 06603762 Lab Use Only: <br /> Sample Number(00H number plusive digits). <br /> DOH Form @331-319(revised eisa <br /> • <br />