Laserfiche WebLink
�- <br /> . osHsn.ir3w+-„i �. <br /> i <br /> r, <br /> ' ,STAT�OF WA3HINGTON � <br /> ' � ' DEPARTMFNT OF SOCIAUANL HEFLiH SERVICES <br /> . ,WATER Bl�CTF,RIpLOGICAL ANAL`":ilS <br /> . , l'.".1:1 i:J': bF. .'�' ( .ii^:l- i 1C, 7i ;d i�.. (rlF� <br /> ' � II inslructions am not lolli wed,sample will be r c1ed. . <br /> �ATECGLLECTED TIMFCOLLECTE� COUh1YNAMF. �, <br /> �MONiH 01Y YGR ' : � '� , . I <br /> !.. . ;_ ❑ ALt ❑ PM '. . . <br /> TYPE OF SYSTEIA IF PUBLIC SVSTEM.COMPLETE: <br /> i <br /> (�� LIPCt!CldS$ <br /> C� Pueuc I.D. No. �I I I i � 3 a <br /> L� worvioun� ��J <br /> �,a�� <br /> NAMEOFSYSTEM ' ���� � '� <br /> � . �� , _ ' � � '� .. „ �. <br /> S�CGFICLOCAi16NWu[PES��AIPLECOIIECif�SY�-�ElaO.YNCflIMGPNA1AENi�1ELER10NEN0 � �, <br /> no �n�.� .n . an,o� i�,.va��,.�o,mu.i �i <br /> i `. . . � - . ' . �. <br /> .�! .�� ,., ,�Y � ) <br /> SAMPLE COLIECTED BY:�Hame� <br /> � � � � ' <br /> SOUHCEiYPE , <br /> ❑ SURFACE ❑ WELI ❑ SPRING ❑ PURCHASED [],oOOM HIERTION � <br /> SEND REPORT TO:IPnm Full Name.RaWev and 7ip Coael <br /> , � - C ( L. . . ' . <br /> --_ i <br /> ' � � WASHINGTON � <br /> TYPE OF SAMPLE � , �. <br /> ICM�U.nhrn��rnrsc �+m - <br /> 1. O OFINKINGWATER C C�IariT�(e4���y^� !,:��Tq1��V�I;—}r �� , <br /> checktreatmCnt—> ❑ Fill^i�.d•�{ I`, �b I �'J fS <br /> ❑ JNm'L�r Oiher �, <br /> � 2. J RAW SOURLE l7ATEF 0� i 0 g i982 ! <br /> � �, 3. QNEW CONSTFUCTION or REPAIRS <br /> 4. ❑ OTHERIS�ecilyl___.— �, <br /> - _ . . ......_..............._............... <br /> LOMPLE7E IF iN15 SAMPLE IS A CHECK$Q�L� OF EVC'RET I � <br /> . ,�'� - � G Y - <br /> an�vioisiFo�aa PuL:ic WOrks Dcct. <br /> 1�9EVIOUS SAMPLF.GOLLECTION DATE � <br /> . . _ .. ._—cl_ <br /> REb1A�7k$: — . <br /> ' _ __ " ',, . . _ .. - . <br /> LA90RATORY RESULTS IFon�ne u5E or+�v1 <br /> IdPN�COLIFORh1 STD PLAi E COUNT I SAMPOEC USEESTED <br /> � _/5��oa,��.,��.� /nn � <br /> MVN pIWT10N TEST UNSIIITA�LE � Sample Too Oltl <br /> ���^� 1. 0 ConllucN Gmwl� ❑ Not in Proper Gon'alner . <br /> MF COLIFORM <br /> 2, [� THTC � Insulilcient Inbnnallon � <br /> ' �OOm'� P�oviAe]—PleaseReatl <br /> Inslmc'Inns un Form <br /> FECAL COLIFOHM 3� C '=5 oeeas <br /> � I � MPN G MF � , � _ <br /> �OJ�`� _ <br /> FORDRINKINGWATf'� '-IdPIESONLI,iHESERESULTS.RE: � <br /> �' ❑ SATISFACTOFV ❑ UNSATISFACTORV _ <br /> _ . ..,. ., . .., <br /> 'Fp_�VF�.� I . . � I . ., .. <br /> �A9 N0. � DlTE TI�AE REGEIVEO— P`CEIYED BY <br /> • �� ) �_� <br /> DATE REVORTEO L4BCr1ATOtiY: ,, <br /> PEMARNS —� I <br /> � WATER SUPPLIER COPY . � _ <br /> - „ <br />