|
Sreu a1Wo�hlne�en Aah e1We�tiln0�en ^
<br /> �` Drper�mrm el Se<iel end Wal��aNm �\. O�Oon1nrn�ol Sxlel entl NroAA fedaw / ♦
<br /> � NmOh Se.rin�DiriJen � � M bHtn DidJon I 1
<br /> JSTi�h7oww,S�nnb.Wmhinq�e veiw �i Smi�AfeM e.We�Mnq�on i11W v
<br /> W,Q?ER BACTERIOLOGICAL ANAL IS WATER BACTE�LOGICAL ANALY515
<br /> �� NEAD INSTRUCTIONS ON lACK Of GOIDENR00 COiY E � AEAD INSiRUCilONS ON lACN OF GOIDENNOD CO►Y �
<br /> Ii INSTRUCTIONS ANE NOf PROPFRIY fOIIOWED, If INSTRUCTIONS APE NOT PAOOERLYFOIIOWED,
<br /> fAMFIF WILI EE NEIFCTED. SAMPIE Wlll 6E NEIECTFD.
<br /> -,_' ' _ _"- 1 __- ..: _,-- - . _','___— -
<br /> ___ _ . ' _ __ _.. ..___ __ _
<br /> fONlAEUSEONIV CO.�CITY ���� FONIAEUSEONIY CO.CITY ���� �� �•�
<br /> ll.! NO LA NO.
<br /> 7vUv7'a Z �6 Aa?6 I.
<br /> DAfECOIIFCTED �.,�, � DAtESTARTED vn u.em DATECOIIECtED ���:�. DATESTA EO n., �n�m
<br /> No��n Dn, rw�� .i ��� � p��u - �
<br /> -�/%; ���-5�--�5 . .� A f _., �,�- �y
<br /> TIME OF DAY � � 1 D.NO,IP�bll<Sytlem�l �COUNIY NAME TIME OF DAY � .� �D.NO.Ou611t Syibmfl COUNTY NAME
<br /> WLLCQFD �(Mr � " '^ • .•.. I COLLEQFD OxM I �• I +^ ,.{
<br /> � ❑' .�: 3 � .� � IJ I I �_ ��i 1 rrd l71���� 1j � ..�V�(i .
<br /> ���OIY/�IE�f�SfFM .�.. .- .. - �'- - �--- NA�[OiWAIFYSYSIFM _ .� � .- URflfRA55
<br /> . _ � . . (�NAI Cin�.s � � � �. I_ i i�- ] �
<br /> r i .. �
<br /> � � i . _ , . � .� -,_1=11_._. __ -_. �_y r � .�/ �
<br /> _..1_ ___"—�__'_'.__-___- . ___.'-'__.__ .
<br /> ftS1FA��DOtESI - � " STSIEMADp�[SS „ �
<br /> . : J .
<br /> l0[�110NWNE�ESAMRlW�SCOyF�REU�Irnda�leneheal5�ha.ael � IOUtIONWHfIES�MREW�SCOIIfUF��kndo�lon,��hee��p,�h�
<br /> '✓.: ��; +-_.. L�: - --• � ' - �� -- _ _. , --i.rh��� . �' s � i'fE
<br /> C01lFCIFOlY�.INem�1 . � � tOlIfCTEO�I�iNamr _ /.
<br /> 1 ' , "
<br /> _—l.f-.�l.i / ` , ' ' ' �..1__—__._"- � _ a-�.-�l. ._�__._�_.L��_�--_�—.
<br /> TYIE Oi �..� � �.MUnidPal �Indwbinl ►rivm� TY►F OF �o� � �-- Monmipal or Z � Indufhinl or]� �rlve4
<br /> SYSTEM Cemmuelty °�� �-� Commeraial ���� Refidenu � SYSiEM , CommvnnY Cemmerdal 1Mld�nt�
<br /> _-._ _.- _____- __-_-__ -_____-'_. ._-- -,
<br /> SfIJf1PCFORiiO '�'��n�l�JiNu•.�� R.bf:��� ��,d; rt�i,• f 'INi]PEPORIIiI I'��r.���r�Nnmr �J,v�vnndl�,Cotl•� �
<br /> _.-� ' � i� (—_ ._-_. :. - � ,��•�',`� _ .y /i,,��� �' /�i(�/.
<br /> � �� i� � . . �� l
<br /> . - / -� U. :. , i 'T
<br /> - -- � ' �y -
<br /> �- !� � �� I �•__ ' WASNINGiON 'S j t� .•4 ��ir !'i_ % ._�_...._ .....: WASHINGION/r(' /�
<br /> L
<br /> -___�_ '-_ _'- _ '--.--- -z�'._..-__-_ . _
<br /> �
<br /> yUUu�!fYPE on ' SC�UpCF 1YPF an nomhme•�en
<br /> � , �°'"m"°„"" iL, s,,,ro�. 7Ow.�� nC� o,,�no�.a oO ,o�n.,
<br /> i � ,i,��. 7 O w�i� a O n r�,<n�,.a v O ,o��,., � a O sr,,.q
<br /> _ �.,,,.�„
<br /> lvl`I UF SAMFIE ""' �CHt(K oNE[m v, ivPF Of SAMPL[ '��' u�F[KCNF o�n H,w Sw�mm�np Sw�mm�nq
<br /> N�w $w•mm�nq Swimmi�q p��w
<br /> I Q P,va..�qW���i 7�P�� J� Mn.�, A� �'onl 5� Rmah � Q Dr�nb.in�4,v^� 7�� �Mo�n 40Poo1 5� Pm�h
<br /> Wwr. � Wn��r
<br /> S���iP,�q' prp�r ' $nn.rnry Stie�I1nF O�her
<br /> r�(7 ��,...� 7� Srnwnr., 8(: °���nv 9(� �x�val�i ' hl7 tiwv.� 7�) S.�.wn�., B� S�uAr 9� �Snrolyi
<br /> IS LUS SAMPIE A iOILOW�U7 10� iS iHiS 5/+MPIE A�OLLOW U�!O A n��
<br /> �R(Vi0U5 NJN CONFORMINGSAMPI[��� I O Vy G .�J No �REVIOUS NON CON40RMMG$AMPIE° �O�es O,O�No
<br /> 6 vFS GNE PREVIOUS lAB NO IF vF5 GWE PHNIOUS lAB NO —_ —
<br /> SvSfFM TRfA1MEN( Kn.A o,J�Ip�D����m�Wm��Sn��plei� � m S�S1EM ikEAiMLNi �[n.d o�b lo�D�mbnp wo r Snmplai
<br /> i 4�1 w �. 2 O rnmmm��,.. 3 O r.��„���� n O n„o,a��.o� i�G�(No.,. a O c�i�,,.,����., � O r,o,�„o� 4 O{IuonJn�mn
<br /> vOrnn.,�soee����� r ���;, .. sr•�,�r�— --
<br /> PEMAAKS -'-- -"'�' - �- I 4'1",�nu�y
<br /> � _
<br /> � �ARORAIORV RESUl15 � ' � LAPORAIORY RESULiS �
<br /> 5[FREVFRSESIDEOFPiNKCO�YfOo1NiEAPR[lAilONS � �FFRFVFRSFSIDEOFPINKCOPVFORINffRPREiATIONS
<br /> A (OI II�1�MS PFR I OOmI � FCCAI COIIFORM ❑ AESUPMR SAMPI l � ���,�f ORMS PCR 100�.��C FECAI COUFORM ❑ RFSUBMII$AMPIE
<br /> SuiPIM�"i�fSt .�m �IOOmI I�oUm��nnF�•P•�,n.�. '. �'.'�'IMPNfF51 �.m MCN- IrvUmm�nbbfl.mou
<br /> M�N_ � ;100m1 m i Q Ccnliuln�Growih
<br /> ' �--� „ s-.�x oo�i ❑r�„a,,.�,u�..,�. � ❑.—. o�s -o;
<br /> os.nni_� _ E _ 7 O IMf � � m�ei_� -E _ 1 O tNiC
<br /> I ❑�• i,5. 77 -� t,5 • ]: /IOOmI
<br /> Mi /IOOmI 10f.rmD.�,n �6 _ IOE.rq�D.E��s
<br /> � 'l]--� ]i 5.S I _�_ E _ n ❑ � �--� 7�5 • 5 1 u�a _�_ E — � ❑
<br /> � ❑y ��s�y7 �� , < Q� 7�S�v7 � R[SUBM115AMFlE n��ni
<br /> •❑RFSU9MIi tiAM%E �+�+n 5 ❑--� u5 � in
<br /> 5 Q--+ ai5� �E S�mVI�Reiec�atl P�mus� �C�.r�OnrOr IJwre� Somple Nele<�td Bemm! �CFed OneOr M�,..
<br /> .. p� s,s..ie i ❑s����i.t��oid _ np.� s-s-.�n i ❑s�m�i�i000id
<br /> M�_ /IOOmI Y ❑F�t No�Provitl�A . r,�� /IOOmI 1 ❑F�<No�Pmv�detl
<br /> . ..,� E � J ❑Sampl�R��ervetl lon l���e In W�ek ,. � 7 ❑S�mpl�Re�e�vrA Too larr In WerL
<br /> • _ - 4 ImalLorn�inl,�,mn'�nn f'r�v��1rA
<br /> M�N 0�1M1 IE515 � ❑ImolLben�Inla�moean Prav�ded M�N InW 1�5�5 �
<br /> /100 ml Plsme fwd In�vor�wmOn Fmm _ _ ��00 ml Plra�r��-i,,i.��,���,•am��O���n�m
<br /> ...� . E_ 5 ❑Nor I�orop•r Conimner �...e�_._E_ 5 ❑Nm In Dron•�� �.,r=��,���
<br /> B StD PIAiE COUN! C ❑:eaA�dOu� B 5I0 �IAiE COUNI e. ❑l�o�rd�,��"
<br /> � ❑O�her�5pe<dyl � � ❑O�heri5p�o�c
<br /> /ml _ /ml
<br /> - 1
<br /> � n�sei-� _f� -_ _ ..___.__. .. . .__-
<br /> , . . _E_ . —__._-- .. .._-
<br /> RfMARKS • REMARKS
<br /> '-' - DAtC6TIM �T— Cy
<br /> DMFAIIMf� . �������n•, �'�� � DAt' �' � '7
<br /> C� / 1 ��^'� �. ?� RCCFNED V �7 �� / '
<br /> RECFiVFDI'l' -> I �.�-'f _�Lv•,nPl(Ij,^. � �%'' � � - � � � I COMPLEIED
<br /> __._ - . _ . __J___ -- I
<br /> I
<br />
|