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• <br /> AmTest Laboratories <br /> I. S <br /> e o � !s 13600 NE 126th PL STE C,Kirkland,WA 98034 <br /> 425-885-1664 www.amtestlab.com <br /> COLIFORM BACTERIA ANALYSIS <br /> Date Sample Collected Time Sample County: <br /> 05/20/2015 Collected II AM <br /> Month Day Year 11:55 0 PM KING <br /> Type of Water System(check only one box) <br /> ❑Group A Public ❑Private Household <br /> ❑Group B Public J Other: <br /> Group A and Group B Systems Provide from Water Facilities Inventory(WFI): <br /> D# N/A <br /> System Name: BOEING EVERETT <br /> Contact Person:CHRIS WILLIAMSON <br /> Day Phone: Cell Phone: 425 864 0020 <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): RICK OLSON <br /> Specific location where sample collected: <br /> 8" POC WEST OF AUTOCLAVE 40-55 <br /> Special Instructions or Comments: BOEING EVERETT <br /> Type of Sample(must check only one box of#1 through#4 listed below) <br /> 1.0 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 /> Chlorinated:Yes No <br /> Public Systems must provide Source Number from(WFI) Chlorine Resid:Total Free <br /> 4. Sample Collected for Information Only <br /> ❑Construction 0 Repairs 0 Private Residence RI Other <br /> LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY <br /> ❑Unsatisfactory 0 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) ❑TNTC <br /> ❑Improper Container 0 Turbid Culture <br /> ❑ ❑ <br /> Bacterial Density Results:Plate Count /ml.E.coli /100 ml. <br /> Total Coliform <1 /100 ml. Fecal Coliform <1 /100 ml. <br /> Method Code: Date Received: <br /> MICR-2810 5/20/2015 <br /> Date Analyzed: 5/20/2015,14:00 Date Reported: 5/22/15 <br /> 06603087 Lab Use Only: <br /> Sample Number(DOH number plus five digits) <br /> DOH Form 4331-319(revised 8/05) <br />