Laserfiche WebLink
--- OSHS 19�tiJ IRt Ap <br /> STATE OF WASNI!:3TON <br /> DEPARTMENT OF SOC!AL AND MEALTH SERVICE5 <br /> WATER BACTERIOLOGiCAL ANALYSIS <br /> sna�ru �ai��ci�rn: i<<nu ir,�srNucno;�s ur, o��cr; oF co�o��utaan ca��r <br /> tl in;tn,ctions are not followed, sample will be re�ectetl. <br /> D!.iE COLLECTED TINE COLLECTED COUNTY NAME <br /> MON�H OAY YEFR -- . <br /> � .,_ _. - !-� O AM ❑ Pi4 -� —_ <br /> TYPE OF SYSTEM �F PUBUC SYSTEM,COMPLETE: _ <br /> CiPLLE LLA55 <br /> � aueuc I,D. No. i z 3 a <br /> �. ❑ INDIVIDUAL <br /> i i5.,.e,o�a+,asmmcei <br /> NAME OF SYSTEM <br /> i - � � <br /> ' . �'.� � �I-:C / . : � . _ . _ <br /> SPECiF'C IOCATION WHEBE Sl+MVLE COLLEGiE�SVSTEM ON'NEA�IdGR.NAMEANDiFlEN10'aE HO <br /> r� xncn��uo e�.cnooi.e,��uem.m�ma�m � <br /> � � i _ . -�._ ( ) � <br /> SNMPLE COLLECTED BY:�Name� <br /> � <br /> SOURCETYPE + <br /> COMBINATION <br /> ❑ SURFACE ❑ �VELL ❑ SPRING O PURCHASED ❑ orOTHER <br /> �. SEND REPORT TO:IP�inl Full Nama,Aeeress and Zip Codo� �' <br /> . . � - ..� . r:: . <br /> . � ^ WASMINGTON ' __ <br /> TYPE OF SAMPLE � <br /> IG�ett o��r one�in inis coWmn� '�, <br /> � �, Q DRINKINGWATER � Chlorinated�Resitlual:_Total_Free) i <br /> check Ireatment—�-> 0 Fillered �i <br /> ❑ Untreate�or Other , <br /> � 2, ❑ RAW SOURCE WA1ER . <br /> � 3. O NEW CONSTRUCTION orREPAIRS � <br /> 4. O OTHER�Specily) ��. <br /> . COMPLETE IF TNIS SAMPLE IS A CHECK SAMPLE , <br /> PFEVIOUS lA�N0. ��, <br /> ' PREVIOUS SAMPLE COLLECTION DATE__ — <br /> i REMAPKS: � <br /> � LkBOHATORY RESULTS tFon�ae use or+�rl � <br /> MPN-COLIFORId STD PLATECOUNT SAMPBECAUSEESTED ' <br /> � �SwM.no�ni.. _ �ml , <br /> � MPNDIWTIOtJC TESTUNSUITABL� � SampleTooOltl <br /> '�--�— <br /> � �OU ml �, Q Conlluenl Growth ❑ Not in Propm Contalner � <br /> � MFCOLIFORM 2 � 7NTG � Insullicicnt'Inlormatlon �, <br /> � �O�m� Provitled—Piease Read <br /> Insiruclions on Form <br /> �, FECAL COLIFORM 3•�� Ezcess Debds �, <br /> I <br /> ' ❑ MPN ❑ MF 4 � � i <br /> 1 �OOmI <br /> , FOR DRINKING WATER SAMPLES ONLY,THESE RESULTS AFiE: ' �' <br /> ❑ SA7ISFACTORV � ❑ UNSATISFACTORY ; <br /> � SEe REVLRSE SI�E UF GREEN COPY FOf7 E%PLANATION OF RESULTS <br /> � UB ND. �AiE,TIME RECEIVED— ���!!� RECENED BY 'I <br /> /� 7L <br /> �� 'Zd1 '705 3.� �-�'� ' <br /> ��.. OATE REPORTED � LABORATORY: ;.� ' <br /> .. i_ � �(� �� <br /> _, �7-,f'��'�, � <br /> REMAPKS <br /> WATER SUPPLIER COPY �' '�� <br /> � , <br />