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F.'�1ERETT HEALTH DEPA.RTMENf <br /> WATER <br /> Name � _ ,� � Addreas �,� � <br /> �i- tx�Db C!�/'w.i.�-�-z�+ ✓� <br /> Collected y � ru,tT� Date and time collected - <br /> �p•3p 9�M. <br /> Source of water <br /> Point xhere eample was taken �,(� <br /> :�esidual chlorine ppm. <br /> Report tot Name ���,�« / <br /> �.'-�-���— <br /> Addresa <br /> LABORATORY REPORT <br /> Laboratory number ��p{ �Oe received d-zy-r-r� nate completed_�r���� <br /> Coliform Geoup �,f; y ,'�, /,�va per 100 cc. <br /> Agar Plate Count, 37C, 24 houra /0, •0o per ca <br /> Enterococci GrOup �i,.. �r�+.�! ��f� �per 100 ec. <br /> ---`r�����- <br />