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STATE OF WASHINGTON <br /> DEPARTMENT OF HEALTH <br /> WATER BACTERIOLOGICAL ANALYSIS <br /> 5?.'�4PLE CO.LEC7ION�.READ IP1SiRUCTIOtJS ON LACK OF GCLD'cNROD COr'Y <br /> II incimctbnt are no1 IolloweQ sanipla wlll be re�ecteG. <br /> �FTECO;:EC7E0 7'�5'ECO:LECTEG CCU'+TVNAVE <br /> MONTH �4T YEAF �� � � <br /> 7 � `_ �r� `� AM _. PM '�'.� '�� I _ <br /> TVPE OF SYSiEU IF PUBUC SYSTEh�,COA�PIETE <br /> S,'y PUBLIC LIRCLE GFOUP <br /> ❑ ItlDIVIDUAL ��D.No � I I A e <br /> Is.nomq�,nwnn <br /> NA�AE OF SYSiE1A <br /> . i ��' ' i �,:��:..,. � �". <br /> SPECFIC LOCAiION wNEnE SAIAPLE CCiIECTEO TELEPHONE NO <br /> � , i, �RYI�(Y_�1 _ - <br /> � . . , i /;�' _:I' <br /> I._ ;.� r. �lii, ��' �, � (: , EVENING� ..�. <br /> ,S/AfPLECCYLECiEDBv.(Name) � SYSiEMU'N�iERMGR i��amel <br /> k��f-p� ij� -_ �c,•_ j. Vt- ; . <br /> SOURCe TYPE LI GROUNO WATER UtlOER SUr�iA�E MFLUBICE <br /> �_� SGRfA�E �I YiELIrn � SPOV�G � PURCHASE�a -' COh161t1A710N <br /> 1YEUFIElO INTERiIE '" o:OTHER <br /> SF D REPORT TO�Pum FWI Name Atr7iess oM Z'.p CoOe) <br /> F. � � <br /> � � � ..wisiw�� <br /> TYPF.OF Sa�i PLE i=�eax cury o��¢�n ms ca.�r7 <br /> � <br /> , PGULiN'c ' � CnicnnatcJ(Pesia�ai _ _ Toiai . _ _ Fee� <br /> �RI'.RLtiGWA7.P ,� Fi�lerea <br /> c:r'vuea:n,ent _� _, Urv„ealcqu0mer_ <br /> � REFEATSA4PLE <br /> Pre.���s o:�.�lampresence la< < _.__'_ _'_____ <br /> Oaie C¢r:'.ed <br /> n+:�50URCE YiATER Sawce� � � � icia�C^e�„m, <br /> :FdCCNSTRUCTIONoiREPRIRS '.� Feca'.Co.qnn <br /> _� O�McF ISD°olyl <br /> Rer.+aans� <br /> (LAB USc ONLY)DHINKIN,^a WATER RESULTS <br /> -. UNSATISFACTGHV,Co4�oimsp�esenl 'LL S.4TISFAC70PV <br /> REPEAi _ Colilorms n�senl <br /> ¢,�N,�ES .._ E.Coli presem ._. E.Cd�a�senl <br /> HECU:FEU ' � Fecal presenl Fe<al aosenl <br /> OTMEHLA60RATORYflE5ULT5 <br /> 'OTA;COIIFCFM �IOGmi E.COIi �iOG�'.; <br /> FECAICOLIFORM__ 'iCOml PiATcCOUNT _ ._ �m� <br /> AtAiNcR Sa:'PLE FEOUIpED <br /> SAS!PLENOTTESTEDBECAUSE TESIU�+SUITA6LE6ECa�„��� <br /> . . Sample UD ald ❑ ConlWent gro�nm <br /> ._ Wroiigconlainer �I TNTC <br /> .__ Inro�nple�CtOrm _! TwOitlCUIN�C <br /> _ ._._____ J E.cesstleons <br /> SE[f7EVEFSE SIpE OF GRCeN COPY FOR EXPLAYATION OF FlESULTS <br /> L.ld 0( ' i151 __ '�rc TiAEflECEVEO I R�CE�\e�6� <br /> � � i li � �r. IL i . . � _�,iy , <br /> I � � � <br /> ".tER6=Jf��cD�� � ln6'JF;iGFr <br /> �•� �_, . ,_ \-' - -' CITY9F EVERETT <br /> - " - ENVIHONMEMAL I.ABOfilQORY <br /> ',�,;�",' - ... ?2C0 CCUM1R STFCE7 <br /> � EVERE:�T WA 9P�J1 <br /> WATEF: SUPPLIER COPY <br />