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E �' AmTest Laboratories <br /> �°!!e, 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 /> 06/19/2015 Collected 0 AM <br /> Month Day Year 12:30 Q PM KING <br /> Type of Water System(check only one box) <br /> 0 Group A Public 0 Private Household <br /> ❑Group 8 Public RI Other: <br /> Group A and Group t3 Systems Provide from Water Facilities Inventory(WFl): <br /> JD# 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,INC <br /> CHRIS WILLIAMSON <br /> PO BOX 1788 <br /> WOODINVILLE,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 10"NE of (E4S4-- Car <br /> Special Instructions or Comments: 40-34 bldg 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:D 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.coil GWR source sample Unsatisfactory routine lab number:, <br /> 0 Fecal-Surface,GWI,some springs <br /> ID Other <br /> Unsatisfactory routine collect date: <br /> I_S_I_ 1 1 1 <br /> Chlorinated:Yes No <br /> Public Systems muss provide Source Number from(WFII Chlorine Resid:Total Free <br /> 4.li Sample Collected for Information Only <br /> l Construction ;U Repairs 0 Private Residence El 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 /> 0 Fecal coliform present 0 Fecal coliform absent <br /> ❑Replacement Sample Required <br /> Sample not tested because Test unsuitable because: <br /> 0 Sample tee old(>30 hours) 0 TNTC <br /> ❑Improper Container 0 Turbid Culture <br /> ❑ 0 <br /> Bacterial Density Results:Plate Count /ml.E.coli /100 mL <br /> Total Coliform /100 ml. Fecal Coliform /100 mt. <br /> Method Code: Date Received: <br /> 6/19/2015 <br /> Date Analyzed: 6/19/2015,14:15 Date Reported: '6/20115 <br /> 06603763 Lab Use Only <br /> Sample Number(DOH number plusitve digits) <br /> DOH Form e33i'sue(revised 8105) <br /> • • <br />