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• <br /> 0/9-) <br /> • AmTest Laboratories <br /> ._ 13600 NE 126th PL STE C,Kirkland,WA 98034 <br /> L :. V o e n ♦ 0 n e s <br /> 425-885-1664 www.amtestiab.com <br /> CCLIFOR I BACTERIA ANALYSIS <br /> Date Sample Collected I Time Sample County: <br /> 01/04/2016 Collected Q AM • <br /> Month Day Year 9:00 ❑PM SNOHOMISH <br /> Type of Water System(check only one box) <br /> ❑Group A Public 0 Private Household <br /> ❑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: <br /> Contact Person: <br /> Day Phone: Cell Phone: 425 864 5645 • <br /> Eve.Phone: FAX: <br /> Send results to:(Print full name,address and zip code) <br /> CHRIS WILLIAMSON <br /> 7733 W BASTION RD <br /> WOODINVILLE,WA,98072 <br /> SAMPLE INFORMATION <br /> Sample collected by(name): ED AUSTIN • <br /> Specific location where sample collected: <br /> LIN PAD RE-ROUTE <br /> Special Instructions or Comments: <br /> Type of Sample(must check only one box of#1 through#4 listed below) • <br /> 1.El Routine Distribution Sample 2.❑Repeat Sample(after unsat.routine) <br /> 0 Distribution System <br /> Chlorinated:0 Yes 0 No ❑ 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 /> 0 Fecal-Surface,GWI,some springs <br /> ❑ Other <br /> Unsatisfactory routine collect date: <br /> L_s—I <br /> Public Systems must provide Source Number from(WFiI Chlorinated:Yes No <br /> Chlorine Resid:Total Free <br /> 4.RI Sample Collected for Information Only <br /> C1 Construction 0 Repairs D Private Residence 0 Other <br /> LABUSE ONLY.:. _`::DRINKING WATER RESULTS.::;.?:;;LAB USE ONLY;: <br /> ❑Unsatisfactory El Satisfactory <br /> Total Calif arm Present and • <br /> ❑E.coil present ❑E.colt absent <br /> El Fecal coliform present 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 ❑Turbid Culture <br /> ❑ ❑ <br /> Bacterial Density Results:Plate Count /mt.Ecoli /100 mt. <br /> Total Coliform <1 /100 ml. Fecal Coliform <1 /100 ml. <br /> Method Code: Date Received: <br /> MICR-2810 1/5/2016 <br /> Date Analyzed: 1/5/2016,15:00 Date Reported: 1/6/16 <br /> 06600025 Lab Use Only: <br /> Sample Number(DOH number plus five digits) <br /> DOH Form 8331-319(revised 8r05) <br />