Laserfiche WebLink
Sep 22 2010 2:53PM HP LRSERJET FRX p•2 <br />TIME Rb.:EIV -DIN LAB RECET, _,D BY: <br />Routt County Department of En'viro'nmental Health <br />REPORTING FORMTOR. BACTERIOLOGrICAL ANALYSIS <br />SANTLER: PLEASE FILL OUT ONE FORM' - FOR EACH INDIVIDUAL SAMPLE SUBMITTED <br />DATE COLLECTED I1.' 1. l <br />PWSID COUNTY:-,-z - <br />(Public Water System Identification Number) <br />SYSTEM/ESTABLISHIMMNT-NAME: T r y? <br />SYSTEM ADDRESS: C_`0 <br />MAILING ADDRES S 77,16- ITY r _STATE ? ZIP <br />ONE: `77? 7 r° FAX: 7D <br />CONTACT PERSON; -- -r'?---? <br />SAMPLE COLLECTED BY: _ TIME COLLECTED: fqQ arrL/pm <br />WATER TYPE: RAW [ ] GWR [ ] CHLORINATED [ ] OTHER TREATMENT [ ] explairX <br />SAMPLE CHLORINE <br />'pn' x" R IJ ?`?' 1 r t7 ) / A 1V-40 -- RESIDUAL; mg& <br />] . <br />SAMPLE TYPE: ROUTINE [ ] REPEAT [ ] SPECIAL PURPOSE'[ <br />For Laboratory Use Only Belosy This Line <br />Q <br />LABORATORY SAWLE DATE RECEDED IN LABORATORY ! <br />COMMENTS : <br />PARAMETER RESULT. ANALYSIS DATE LAB METHOD <br />Coliform, TOT AbSen esent) 1 ti' CoM 24-hour <br />Colifonn, E.COLI (.A:bsenVPresent) Colilert 24-flour <br />OD = Outdated - Please resample <br />LA = Lab Accident - Please resample <br />Absent- Coliform not detected <br />Present = Colif rm detected <br />S E P 2`1 2090 <br />Reviewed & Approved Title Date <br />Routt County Environmental Health Dept. Phone (970) 870-5588 <br />136 6`h Street Fax- (970) 870-5404 <br />PO Box 770087 <br />Steamboat Spriugs, CO 80477