Laserfiche WebLink
STATE OF WASHINGTON STATE OF WASHINGTON <br /> DEPARTMENT OF HEALTH DEPAHTMENT OF HEALTFi <br /> WATER BACTERIOLOGICAL ANALYSIS WATER BACTERIOLOGICAL ANALYSIS <br /> SAMPLE COLIECT10N.READ IMSTRUCTIONS ON BACK OF GIX.OENROD COPV SAMPLE C011EC710N�REAU INS7RUGTIONS ON BALK OF GOLDENR00 COPY <br /> X IMlru<Ilona b�nat Io11oME.umPb wlll Ce ro�K1aA. X M�Irvdbn��n nollolloME.s�mOM wlll M nMcIM. <br /> D�7ECIXlEC1ED ItIIMqEGOIIELTE.D-f GONR1'H�ME OATECOl1EtTED TI1.1ECOlL)ECT�E�D LOU1Tr/UMF <br /> MONiM D�v VE�R y� . �v Mdl1N/ OiY / YE�R � • LSG_ Sn�.;+romish <br /> `1 � I �p h1 nu i rM Snohnmish � f� �M I 1 vM _ <br /> ttPE0�SY5TEM IfPU&ICSVSTEM.LOMPLEiE T'PEO�SYSiE�A FP19lIC5Y5TE4.LW�'.ETE <br /> \ PUBLIL t� E�ROUP X��. VIRIIL '2 4 O S O L C EGRWP <br /> ID No Z 4 I) 5 n �. � B � I MDMW�I ID No � g <br /> I I INqVIWAL �s.�...o-w��.e.�n <br /> iu...��.+r�n�.w.i <br /> N�ME 0�SYSTE�A NAME L'�SYSTEM <br /> Cil�� of G��crctt, Public �1'orks Dept City of F.rcrctt, Public 11'orks Dcpt <br /> SPEGiICIOL�t10NW11ERESUAFIECALLEGiEO TElEP110NEN0 SPECK1LlOCATqNWH[RESAMRECOLLECTE� TFLERqNENO <br /> �fO� �";�� s.N;�e o�riqZg� Z57-8824 �rv�F,:�< <r',v'cC'_ °"��425� 257-R824 <br /> \ �vt...�0 wr.�.ro ^ <br /> �/�l J 5 I A' EVENM61OZ51 2$7-A821 � f� � ev�Ninc�42$ � 257-8821 <br /> SAMRECOLLECTEDBY�Name� SYSfEMONMFR'11GR �Name) SAMPIECOLLELtEDBY�Hrn�� SY5IEMJNt4R'MGN (Mt.el <br /> � �� ,_i,a...� s Tom 7'hetford _ � .- •,? 'I- �} S Tom Thclford <br /> SOURLETYPE I� GROUNDWATERIMOERSURFACEMRUEIN'E 50UNCETYPE C] GHOIIhOWATERUNDEFSURF�LEINFIUENCE <br /> �, SURf�CE ��� NfLLFIEID I7 SPRING �.� �qMA5E0a �_� d071[RT� � SURf�LE ❑ WELLFIEID I� SPRMO � PUICN�SEDa � � aCO�A�pTqN <br /> SEND 11EPONT TO�Prr1 id Name M6tu W ZO�1 SFND REPORT TO�R+1 FJ AE7reft Ip WEeI <br /> �N7CODllif1►111LQL�IIII-CLQ�AC4IlS.1'���� �n�•ironment�Q��_cLn.dnrnn Crotis <br /> �����,r� --- z�00 ('cdar Strst <br /> F.rcrcll ..�.�,w 98201 E�'crMt ..a«:�w 9R201 <br /> neeoFsuAaE��Maor+roi.�mncdmn� ' 1PEas�1MRe�u�edmryarnhncdum� <br /> 1 nourrcrt cr��a in�a,y -----Tar 0�� <br /> f� aourirrt � crw+uroein�vaw _ro�n�ltbS� „�i ❑ L� <br /> D{IINNINGWATER � illare0 � .� ��INGW�TEP 11� FMveO <br /> f�lCkhlllTnX ._� �J IMrtiIEEp011K�.._ _ ._ .. _.___._—. .. .. � tlR'�IRNRMt .� i � Un1rN1lOV011k�. .__ __._ . .__.__'—__ <br /> I <br /> I ) REPEATSAMPIE i L� flEPEATSdMRF <br /> PrtxdbmMpmpnerce LIE� __. HMunOOWmpekm lWl _ _. .__.... ___—_'"'".— <br /> DHeCdMaN _.__'_I_. I_ . i M�COMneE _ ___'!_ _____..'�-_ —_- <br /> ;_� w��sou+cEw�hn s�. � G� 0 1 f 1 rancwa,�, [p]� MWSOIRICEW�iEP saws� � 0 1 [7 rarcaw� <br /> ��(NEWCONSTRVLiqNaREP/JR5 � � [ 1 �«rwr�, W M�W�SIRU:11lN1aREPAIRS ❑ F.r+ico� <br /> �] OTHERIk�II . U O�RI�YI <br /> IIEIMIIRS � PEMMIcS <br /> (UB USE ONIY)DRINNINO W�TEN REBULTS (lAB USE ONLY)0111NKINO WATER RESULTB <br /> � I UNSATISFACTORY,Cddormsprasanl �}" S�TISFACTOqV , CJ UNSATISFACTORY.CdAqmeqaten� �1 SRiISFACTORY <br /> CdAorme.osenl Cddarma'Dfenl <br /> REPE�T RFi'EAT �.� E.Coh presenl ❑ E.Cdi ebSeM <br /> SAMRES �-� E Cdipmsorn �� E CdinCunt SAMPLES <br /> REWIRED � i Fxelprnom �� Fenle�sem REWIREO [� Feulpms�M U Fecel�bsenl <br /> OTNER LABORATORY HE8ULT8 OTMERLABORATORYRESULTB <br /> �1o14LOlIfONu i1Wm ELOLI__.. iippm TOi0.COl�OPM _' _ . itOpN ECOII. _ __'__IIOUnI <br /> ffGAl.;Ol6pIM �10dM PUTECOUN7.__. iM ' fELALLOLKp1Y ItOdr1 PUTECOUHi.._... .'__l�+ <br /> ANOTNEHShMI'IEPEWIREO � �NOTMEFS�NPLENEWiRED � <br /> SAUI'LE N07 TEStEDBCGUSE rEST UNSUIi�BLE BEL�USE SAMPLE/qT TESTEDBELAUSE TFSi UNSUITABLE BECAUSE <br /> ! 7 Sample mo alA f I c«�wem o.wnn I.I Semple lao d! Cl conn�em ylo++n <br /> �. � Wrorqtonta�rier �, TNTC l.�' Wrqqconte�ner ❑ TNTC <br /> . . I�ompleln b�m i i Tmba cuiWre '� '� Inmmpllte b�n ❑ TmEM CWlur! <br /> I ; [�cessUetns �-� �-- � ❑ EacesaCeOns <br /> SEF REVERSE SIDE OF OREEN COPV POf1 FXPIGN�TION OF RESULTS 6EE AEVERSE 81DE OF OREEN COPV FOR EXPLNUTON OF RESULTH <br /> UBI+JPC`iGi15i DA�EiMERECEWEfI } REC�ErvEDBY UBNOpqGiTS� DUE,iMIERECEIVED �PFCIVEOBY <br /> � � ... ,r , " � ►�'� - � � , C�' l i �� 11� �� <br /> I � � ,l-: '-�'�i �'�, , � � `� � � �' �_ � ����'r��-,?�` � `;� � ' r� ' <br /> -1'-__--- , <br /> [:q�[aettMrEo uaoa.rqqr. . ne r¢o �y� � �,QPr' CITYOFEVEHETT <br /> �.� �- (' �7� / CINOFEVERETT �,:-i^� �. <br /> i � 'Li ! ��—�� ENVIRONMENTAL UBORATORY � ENVIRONMENTAL UBOMTORY <br /> . 920DCEDARSTREET o-..»,:m,w.,m �CEDARSTREET z <br /> ... , "�:��••��. [VF.REIT.WA 9b201 EVERETL WA 98201 J/5 <br /> WATFR RI IPpI IFRl:/lPV WATER SUPPLI[R COPY <br />