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AIVEE'ST AmTest Labo nes <br /> 13600 NE 126th PL STE C,Kirkland,re <br /> WA 98034 <br /> 425-885-1664 www.amtestlab.com <br /> COLIFORM BACTERIA ANALYSIS <br /> Date Sample Collected Time Sample County: <br /> 12/17/2014 Collected 2 AM <br /> Month Day Year 10:00 0 PM KING <br /> Type of Water System(check only one box) <br /> ❑Group A Public 0 Private Household <br /> 0 Group B Public Q Other: <br /> Group A and Group B Systems Provide from Water Facilities Inventory(WFI): <br /> ID# N/A • <br /> System Name: BOEING EVERETT <br /> Contact Person:CHRIS WILLIAMSON <br /> Day Phone: 425 864 5645 Cell Phone: <br /> Eve. Phone: FAX: <br /> Send results to:(Print full name,address and zip code) <br /> HOS BROS CONSTRUCTION, INC <br /> CHRIS WILLIAMSON <br /> PO BOX 1788 <br /> WOODINVILLE,WA,98072-1788 <br /> SAMPLE INFORMATION <br /> Sample collected by(name): CHRIS WILLIAMSON <br /> Specific location where sample collected: <br /> COLLECTION POINT OF THE 40-82 BLDG <br /> Special Instructions or Comments: Email <br /> Type of Sample(must check only one box of#1 through#4 listed below) <br /> 1.❑Routine Distribution Sample 2.0 Repeat Sample(after unsat.routine) <br /> 0 Distribution System <br /> Chlorinated:0 Yes 0 No 0 Source Groundwater Rule(GWR) <br /> Chlorine Residual:Total Free (Population of 1,000 or less) <br /> 3.Raw Water Source Sample <br /> ❑E.coli-GWR source sample Unsatisfactory routine lab number: <br /> ❑ Fecal-Surface,GWI,some springs <br /> ❑ Other <br /> Unsatisfactory routine collect date: <br /> I_S_I <br /> Public Systems must provide Source Number from(WFI) Chlorinated:Yes No <br /> Chlorine Resid:Total Free <br /> 4.m Sample Collected for Information Only <br /> 2 Construction 0 Repairs 0 Private Residence ❑Other <br /> LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY <br /> ❑Unsatisfactory Q Satisfactory <br /> Total Coliform Present and <br /> ❑E.coli present 0 E.coli absent <br /> ❑Fecal coliform present 0 Fecal coliform absent <br /> ❑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 /> ❑ ❑ <br /> Bacterial Density Results:Plate Count /ml. E.coli /100 ml. <br /> Total Coliform /100 ml. Fecal Coliform /100 ml. <br /> Method Code: Date Received: <br /> 12/17/2014 <br /> Date Analyzed: 12/17/2014,15:45 Date Reported: 12/18/14 <br /> 06607601 Lab Use Only: <br /> Sample Number(DOH number plus five digits) <br /> DOH Form#331-319(revised 9/05) <br />