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� STATE OF WASMINGTON <br /> DEPARTMENT OF NEALTH <br /> WATER BACTERIOLOGICAL ANALYSIS <br /> SAMPLE COLLECTION:READ INSTRUCTIpNS ON BACKDF GOLOENROD COPY <br /> 11 In�Iruction��n not/ollowep,:ampN wlll!�nNctetl. <br /> OAiEC011EC1e0 TIIAECMLECTED LOUNiV ME <br /> MJNiH ��Y fEAR ,1� ��• ��j•�%��� '� <br /> � � � <br /> l]S�li'J �-- '�AM .. PM r'.�; <br /> TYPE OF$Y57EM IF PUBLIC S�STEM,�OMP�ETE. <br /> � PUBUC <br /> fiC�ihDIVIDUPi ��D.No CIRCLEGROUP <br /> i��, A B <br /> NAMEOFSYSTEAI^i/��/��� ��. �>f.,�� /!..-,. %/1�_ <br /> .� . .:i�'��i'F �-//'J%'/�� /��.�'✓%' . � r.iT.n' ' `1f,,/�_ <br /> ',G <br /> SPEC:F�CIOCAnONYMENESAMPIECOIIECTED iFtEPNONENO <br /> !3.�. �t. Ci/G' r'r-' D�Y fe=51 ?:")- 7qC> <br /> .�//�c� <br /> EYEN�NG� � <br /> SAMPtELOLIECiEDBY.�Wne� SYS7EMOWNERUGR (Wm�l <br /> C_/i:j.;•- �.i./I�i:S�i'. / jjn../ T�-;�j� /�.�•;T-S <br /> .... <br /> SOURCE ttPE l� GROUND1vATER UNOER SURFACE itiFWENGE <br /> �-1 SURFACE " �ti'Elld -' SPRING pppC�SEpp ��06�81t14T10N <br /> - 1YELL�iEID `— � INTERTIE aOTMER <br /> iE':D PEPOAT TO IP�st FW!Name.Aovess�m Z�p Coee��- '^' <br /> ;�-�`- .G��.�Y�ikv� /Y' �? •ic/Cr <br /> _.�%'i,� -r '�" /f��'= sl%�G�/C'Lr� <br /> � ' <br /> n.v+ce� <br /> TYPE�F SaA1PLE ICM:t o�'y du in It�s Mumn� <br /> i <br /> �_ RW➢NE � CnnwteGiAesq�v __Toiai __ __FrKi <br /> DflINI(INGWA7ER ❑ GJ1N�y <br /> CkC\IRdMMI � � �4Yr¢dilCqQp�f ___'__ __ <br /> i_j REPEAT SANVIE <br /> Pre��a.saWampesercp llo� <br /> DateCWttleu __i I <br /> L� FA1'/$OURCEIYATER $p�ru� ❑ TGdlCa4iCrm <br /> t- NEWCONSiRUCiICNaPEPAIR$ � m 1 <br /> y`� �� FKniCam�m <br /> �_j OTHEPISpeuhl <br /> RcF1�qN5 <br /> . . . . . d'� i-;�JH�F J�c.��!;cj G . -!' �_ ' <br /> . . . ' _ .i.y/G: -r r'c>.->F'%5:- i,. <br /> . _ '%t_ ...- <br /> �•�; r <br /> (LAB USE ONLY)DflINNING WATEP RESULTS <br /> . UNSATISFACTURY.Co'.��'a'm50�esem I t:. SATISFFCTORY <br /> pEPEAi --. C061o�m5dD5en� <br /> SsMGLES �-� E Coti presem �" E Cah a�sem <br /> �EOWRED Fecal pra5e�1 LJ Fxai aesem <br /> OTMERLABORATORYqESULTS <br /> iJi/yLOIffORM.___fippml E LOII.___i�ppm <br /> FEC�LCOLIFORM____�1C8N PUiECWM mi <br /> Ah01MER 5?�dP�E REOUiRED <br /> S�MPLE�i0TTE51EDBECAUSE TESiUqSViTABIEBECAUSE <br /> J Samplc ICq old ❑ Contluenl growin <br /> �. Wrongconlame� ❑ TNiC <br /> � Incor Ip1e lorm r <br /> -- C TurDi4tulNra <br /> — - � E.cessCe�ns <br /> SEE REVERSE SIDF.UF GREEN CO!'V FOR F%PUWATION OF RESULTS <br /> L:dbO pD�Gli51 O�iE 1iVERECEiVEO RECEiYEDBr <br /> / ��1� �1_L�'_]_i ��'� � � iJ� ,"�� <br /> OFrEf.�:rpn•c, IaBORaiOar <br /> � � CITY OF EVERETT <br /> � � ` ENVIRONMENTALLABORATORV <br /> t.�.;_;.,,�. . 3200 CEDAR STREET <br /> WATER SUPPLIER COPY EVEPETf WA 9B2p1 <br />