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STATE OF WASHINGTON ///��� <br />DEPARTMENT OF HEALTH <br />WATER BACTERIOLOGICAL ANAL <br />SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLD DCOPy_ <br />If Instructions are not followed, sample will be rejected. AI (/�j D <br />MONTH DAY YEAR I 1'-T* y Snohomishv"L�C <br />x /' — / �� ❑ AM 13 PM <br />TYPE OF SYSTEM 1F PUBLIC SYSTEM, COMPLETE: <br />® PUBLIC CIR LEGROUP <br />El INDIVIDUAL I.D. No. 2 4 0 5 0 L A B <br />rsernemYtnmewl <br />NAME OF SYSTEM <br />City of Everett, Public Works Dept <br />SPECIFIC LOCATION WHERE SAMPLE COLLECTED TELEPHONE NO. <br />DAY (425) 257-8824 <br />EVENING (425 ) 257-8821 <br />SAMPLE COLLECTED BY: (Name) SYSTEM OWNER/MGR.:(Name) <br />, 1, (- 474 t John McClellan <br />SOURCETYPE IJ GROUND WATER UNDER SURFACE INFLUENCE <br />® SURFACE ❑ WELLFIELD ❑ SPRING ❑ PTRR ESEDor ❑ COBINNAATION <br />SENEPnEPvORT T0n1PnFM Nam <br />iromentae, OlCa) <br />c/o Aaron Crotts <br />3200 Cedar Street <br />ON <br />❑ ROUTINE <br />DRINKINGWATER <br />check treatment -4 <br />❑ REPEAT SAMPLE <br />Previouscollormpresence Laba <br />Dale Collected <br />® Chbrnawd(Residual: <br />fJ Filtered <br />❑ Untreated or Other_ <br />❑ RAWSOURCEWATER Sources 51 O 1 ❑ Tolal CoMonn <br />❑ NEW CONSTRUCTION or REPAIRS ❑ FeWCOMonn <br />❑ OTHEn(Specity) <br />! 4r z <br />.vep�rc l+7l`i Sli it •4 (C•' -�Y1- %Cl 'J't-! <br />(LAB USE ONLY) DRINKING WATER RESULTS <br />❑ UNSATISFACTORY, Colilonns present <br />SATISFACTORY <br />Colilorms absent <br />REPEAT <br />SAMPLES ❑ E. Coll present ❑ E. Coll absent <br />REQUIRED ❑ Fecal present ❑ Fecalabsent <br />OTHER LABORATORY RESULTS <br />TOTALCOLIFORM 110Dn1 E. COU IIUOmI <br />FECAL COLIFORM 1IDOml PLATE COUNT lml <br />ANOTHER SAMPLE REQUIRED <br />SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE: <br />❑ Sample too old ❑ Confluent growth <br />❑ Wrongcontalner ❑ TNTC <br />❑ Incomplete form ❑ Turbidculture <br />❑ ❑ Excess debris <br />SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS <br />UB NO.(7 DIGITS) DATE, TIME RECEIVED RECEIVEDDY <br />I r <br />DAT EPOSTED LABORATORY: <br />+ � ILI [111 ' ` CITY OF EVERETT <br />ENVIRONMENTAL LABORATORY <br />awn^s 3200 CEDAR STREET <br />WMl6fN]IRCV eprNl <br />EVERETT. WA 98201 r <br />STATE OF WASHINGTON <br />DEPARTMENT OF HEALTH <br />DER BACTERIOLOGICAL ANALYSIS <br />LLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY <br />II Instructions are not followed, sample will be rejected. <br />UY/ +D.{jF.%/OLLECTED I TIMECOLLEECuCT�ErDD COUNTYNAME <br />MONTH OAY YEAR /,4 • 1� Snohomish <br />It 1- ❑ AM PM <br />N1 PUBLIC r CIR LEGRI <br />❑ INDIVIDUAL LD. Ne. I- 4 0 5 O L B <br />Isemee^Y+maennl lJ <br />City of Everett, Public Works Dept <br />SPECIFIC LOCAIRON-WHERE SAMPLE COLLECTED TELEPHONE NO. <br />Lr rr L�yS �7✓✓�` DAY(4251 257-8824 <br />+� 1� �?-L✓c�� t.- c Nw � EVENING (425) 257-8821 <br />SAMPLE COLLECTED BY. (Name) SYSTEM OWNERMIGR:(Name) <br />A c r 0 --i- S John McClellan <br />SOURCETYPE LJ GROUNDWATER UNDER SURFACE INFLUENCE <br />SURFACE ❑ WELLor ❑ SPRING ❑ PURCHASEDor ❑ COMBINATION <br />WELLFIELD INTERTIE or OTHER <br />SEND REPORT T0: (Print FM Name. Address aid Lp Code) <br />Environmental �uali c/o Aaron Crotts <br />3200 Cedar Street <br />❑ ROUTINE <br />DRINKING WATER <br />check bealmeni <br />❑ REPEAT SAMPLE <br />P(Wouscolilornpresence Labs <br />Date Collected <br />fi Ctdonnaled(Residual: <br />ff Fdlered <br />❑ Umeatedor00er_ <br />G'. <br />❑ RAWSOURCEWATER Sources O 1 ElTolal Colilonn <br />ES NEW CONSTRUCTION or REPAIRS ❑ Fecal Cohlolm <br />❑ OTHER (Sporty) <br />nr�nrvlw: � <br />v L" � . • t./ 1.1 Cif'y c, ` ;',?—, %%y06j <br />(LAB USE ONLY) DRINKING WATER RESULTS <br />El UNSATISFACTORY, Colifurms present <br />N SATISFACTORY <br />/ <br />/ Colifonns absent <br />REPEAT <br />SAMPLES <br />El E. Coli present ❑ E. Coll absent <br />REQUIRED <br />❑ Fecal present ❑ Fecalabsent <br />OTHER LABORATORY RESULTS <br />TOTALCOLIFORM I10Dm1 E. COU 1100" <br />FECAL COLIFORM 1IODN PLATE COUNT Iad <br />ANOTHER SAMPLE REQUIRED <br />SAMPLE NOT TESTED BECAUSE TEST UNSUITABLE BECAUSE: <br />❑ <br />Sample loo old ❑ Confluent growth <br />❑ <br />Wrongcontainer ❑ TNTC <br />❑ <br />Incomplete form ❑ Turbidculture <br />❑ <br />❑ Excesseebns <br />SEE REVERSE SIDE OF GREEN COPY FOR EXPLANATION OF RESULTS <br />LAB NO.(7 DIGITS) DATE. TIME RECEIVED RECEIVED BY <br />�� <br />OA�E EPORTED LABORATORY: <br />tirlLl CITY OFEVERETT '� <br />I ENVIRONMENTAL LASORAT nrUZ <br />"ooi�ws`ss msveoxot 3200 CEDAR STREET <br />EVERETT,, WA 98201 z <br />