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F�". <br />STATE OF WASHINGTON i . <br />OEPARTMENT OF HEALTH �' ;f_'�: <br />WATER BACTERIt�LOGICAL ANALYSIS ���1 `'�,? <br />SAMPLE COLLECTION�. R"cAD IP&TAUCTIONS ON BACK OF GOLD'tNnOD COPY � . <br />II Inslmclions are nol lollowetl, sample will Ge rejectetl. <br />DFTECGLLECTED TI;'ELOLIECiE� COU��tYti::'E <br />nio�.H onr �esn � ��' ��f7 <br />l� l� �C6 r nr., 1 ar., Snoliomisl� <br />TYPE OF SYSTEIA IF PU�LIC S�S1E!� C041FLETE <br />%. PUBUG CIRCLEGROUP <br />IJ IIlDI`:IBUAL ���. No. Z 4 O S O I. �p, B <br />SB.es o�ry 1 roamw � _ <br />�JAIdF OF SVSTEM <br />Cit� of G��crett, Public 1Vorks Dept <br />i��ECIFlCLOCAiICNN'NERESAh1NLELCIEGTE[7 TELEPHO':EI10. <br /><,'�(� 9L0� lQ'`�l��r� t✓ onv �425� <br />a I EVENING(QZS) ZS']-$$Z� <br />SAGIPLECO�CTEDBY:!Namc) SYSTEIAO'NtlER1.!Ge'.�t�ame� <br />�� •` ro �'�' s I Robcrt 1Vaddlc <br />SOUBLEttPE ❑ GRWNOWATERUNC{flSUaFACEP�FWEI�CE <br />'� SUfiFACE WELLor SPRRIG PUflCHaSEUcr COMBIIIATION <br />-�� � N'ELLFIEL� � �� It1iERTIE �� orOTMER <br />SE��D qEPORT TO (Prinl Full Name. ACdress aM Zip CoEe) <br />F1n�ironment;ll-SZiullit,v c/o �T:�rk �VCCIis _ <br />_i2110 .edar, trect _ <br />G� crett w,.»u,� 98201 <br />I�; fiOUTR![ (�j' CMonnaledlPesitlual�. Toty":�'�•�Fi, � <br />DRINKPJG'NATER [S� FiticreE <br />checklrealment � ❑ UnVealedm00n <br />I I REPEATSANPIE <br />Previauscd;!ormpr¢stw.c W6». __ . <br />�ateCMmM I__ _I_ . . <br />j j RA1450UflCEWATER Sou�ce� � O 1 i� TamlCc�'o�n <br />�Sj hEYlCONSTflUCT10NorBEPAIRS ❑ FecaILN.!s�T� <br />;� OTf{ER�Speoty) <br />1.'ARKS <br />%>/t`'.o sF' .=il: Gi: e."� C�r..T -[.4�, J t. <br />�./ r�� <br />� <br />:' P > L.%1 �'%y' F�A�-{ ; � /.� <br />(LAB USE ONLVI ORINKING WATER RESULTS <br />�� UNSATISFACTOflV, Culibrin; pmsenl }�I SATISrACTOf7V <br />R[PEAT �� Coldorm; absenl <br />Sar.1PLES � E.Colipresent i.l E ColiaOsenl <br />RF�UIPEO ❑ Fewl present [ I Fecal absenl <br />OTMEF LABORATORYRESULTS <br />iOTAILOLIF�RM___11Wm1 E.COLI___IIIX.MI <br />FP'FICOLIFORM__._ n0.Ynl PLATECOUKT__!ml <br />ANOiNER SAFIFLE REOUIRED <br />_ :?,ENOTTESTEDBECAUSE�. 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UNSATISFACTORY.Co6lorm>pmsem ` SFTISFACTORV <br />CaldorRs absenl <br />REPE>T �_I E Coh resem lJ E. Cali absml <br />�a!�P�ES P <br />fiECuiFlED ❑ Fewi present ❑ Fecal atsem <br />OTMEHLABORATORYRESULTS <br />70TALClAIFOAM I100M E.COLI_ __�IOCnI <br />PiCaLCOLIFOPM If00m1 PLAIELOUNT '�� <br />AIlOTHEfl SAMPLE FEW IRED <br />SA!d7LEN0iTE5TEDBECAUSE: TESTUNSURA6LEBEC�VEE <br />�� Sample �oo oId ❑ Conlluenl gro;:th <br />.. � Wmngcontainer ��'� iNTC <br />� . Incompletelorm ��� Tur�iOtulWre <br />, � _ E*cess tic�ris <br />SEE FEVERSE SIOE Or GREEN COPY FGR F>:PLA^1AT10Y OF RESULTS <br />tF6�ApDIG�TS) DATE.TIh�ERECEIVED FECEIVE�B� <br />, . � 'r- , � . . <br />DATE FEPORIE� u�aR^Tan�. CITY OF EVERETf <br />- � � � � ENVIRON1dENTALLABORA70RV <br />3200CEDAA STREET <br />�� �� � � �� � � � � � EVERETL YJA 98201 <br />WATER SUPPLIER COPY <br />