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_ <br />Ta''-' RECEIVED IN LAB RE WED BY: <br />L? L/ <br />Routt County Department of Environmental Health <br />REPORTING FORM FOR BACTERIOLOGICAL ANALYSIS <br />SAMPLER: PLEASE FILL OUT ONE FORM - FOR EACH INDIVIDUAL SAMPLE SUBMITTED <br />DATE COLLECTED (r / 5 /. L O <br />PWSID COUNTY:_ A <br />(Public Water System Identification Number) <br />SYSTEM/ESTABLISHMENT NAME: <br />SYSTEM ADDRESS: <br />MAILING ADDRESS 7795 /?Gq hI2?741 ??`?1kY ?? ?JL:?2s STATE CO ZIP <br />CONTACT PERSON: /^ HONE: 70 c997 -Ffg-AX: (Q10) v?o23-v+ X31 °/ <br />SAMPLE COLLECTED BY: TIME COLLECTED: 3 f5 am/ r?ir <br />WATER TYPE: RAW [ ] GWR [ CHLORINATED [ ] OTHER TREATMENT [ ] explain <br />SAMPLE CHLORINE <br />POINT: RESIDUAL: mP <br />SAMPLE TYPE: ROUTINE [ jv] REPEAT [ ] SPECIAL PURPOSE [ ] <br />For Laboratory Use Only Below This Line <br />r JUN 15 2010 <br />LABORATORY SAMPLE # DATE RECEIVED IN LABORATORY <br />COMMENTS : <br />PARR MY,TER RESULT <br />Coliform, TOTAL (Absen resent <br />Colifonn, E.COY?S-S- Present) <br />ANALYSIS DATE <br />LAB METHOD <br />oli'ert 24-hour <br />Colilert 24-hour <br />OD = Outdated - Please resample <br />LA = Lab Accident - Please resample <br />Absent = Colifonn not detected <br />Present = Colifonn detected <br />Routt County Environmental Health Dept. <br />1366 th Street <br />PO Box 770087 <br />Steamboat Springs, CO 80477 <br />" J16) 2010 <br />Date <br />Phone (970) 870-5588 <br />Fax (970) 870-5404