HomeMy WebLinkAboutWEC Water Sample Results - 8/21/2023 y N.
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COLIFORM BACTERIA ANALYSIS FORM
Date Sample Collected Tune_Sample County
g r Z I Z 5 Collected C 6AP'11°7
/�////6f7ond, Day Year , •6d „ Mason // / I"Q VPe of.Water System(check only one box) ����� g(�
❑Group A roup B 0 other._ __ / VT
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,roup A and Group B Systems-Provide from Water Facilities Inventory(WFI): l//Yl I V
tern Name: /4 1— )
1141
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ryl$ �Lc�k y 0�
:Detect Person:Brandy Milroy _r-- — r �
lay Phone:(360)877-5249 l
hail: Cell Phone:(360)490-2459 ��
ail:brandym—mason-pudl.org Ev .Phone:(380�t90-2459 M ���NS
lend results to:(Print MI earn.,address red zip code or aurae above for electronic copy of results7) �
brarrdyrnt�mason-Pudl.ory L
_ kVA 98
SAMPLE INFORMATION /1/)��/CD f '"
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Sample collected by(name): ,r --- /"
o- (= instructions or comments:
Specific location whets sample consoled: Special• C
/2.
Type of Sample(check only gfie hex). --. --- �Q
1.ID Routine Distribution Sample(Am) 2.❑Repeat Sample(As) p 76 Chlorinated:Yes 0 ��
N e-- (from distribution system after unsat.routine) �` /ln�Unsatisfactory routine lab number: /7 i/
Chlorine Residual:Total!Free_ 1
3.Ground Water Rule Source Sample Unsatisfactory routine collect data: 41 ,
Chlorinated:Yes N o
❑Triggered t Chlorine Residual:Total ',Free_ ��� ��
0 Assessment(A/P) /Z ( 1,�f .
4.Surface or OWI Raw Source Water Sample(Enumeration) � ( � V v`�— a � 610
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❑ E.toll ['Fecal __r~rmrad Yes—_fro__ �_.LJ ' 'A , (/�J
5'Mamde Collected br Informetlon Only: in I V
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑Unsatisfactory Total Cofifonm Present and
atlsfactory
❑E.cati present 0 E.cofabsent ,
— mpn1106m1.E.coll mpnl't00m1.
Bacterial Density Results:Total Cotfonn - 17\
Fecal Conform _. —cfu110Om1. � ;�
it rE
Replacement Sample Required: ❑TNTC ❑
Sample too old V
❑ Sample Volume ❑Damaged Container ❑ -- NU U 2 1 2023 ({+
lab Reterenee Number J
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Receipt TempC':
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_ COLIFORM BACTERIA ANALYSIS FORM
Date pay Year Sample Collected The Sample County
6
Z 1 23 Collected
Mgt :IkoM Mason CCU
.—. —.=-
Fyne o(Water System(check only one box)
❑Group A gGroup B ❑Other_._.— — w 1
` r b
)`O
3roup A and Group BSystems-Provide from Water Facilities Inventory(WF!):
D# _
System Name: i _
Contact Person:Brandy Milroy — -
Day Phone:(360)877-5249 Cell Phone:(360)490-2459
2459490-
Email:brandym(r�mason pudl.org Eve.Phone:(360)490-2459
results to:(Print tun name,address and dp code a email above fa r eledronlc copy of mutts)
•
brandym@mason-pudl.org
SAMPLE INFORMATION
Sample collected by(name): rl _(c
——
Spedfic location where sample collected: Special instructions or comments:
W e,\k $n. .3 St::- —
Typs of Sanipte(check only one box) — —
1.❑Routine Distribution Sample(MP) 2.❑Repeat Sample(AIR)
(from distribution system after ursat.routine)
Chlorinated:Yes ❑ NoSirUnsatisfactory routine lab number.
• Chlorine Residual:TataL_Free _ __——
l
3.Ground Water Rule Source Sample Unsatisfactory routine collect date:
l S , / --I
Chlorinated:Yes No
❑Triggered (fVP) Chlorine Residual:Total ;Free_.____
Ai I ❑Assessment(A/P)
4.Surface or GWI Raw Source Water Sample(Enumeration) S
❑ E.coil 0 Fecal Filtered Yes-_No�A -
Srmple Collected for Information Only: •
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑Unsatisfactory Total Conform Present and >(Satisfactory
0 E.coil present ❑E.col absent
.Bacterial Density Results:Total Coliform mpnf100m1.E.cofi.__Jn1xd100mi.
. Fecal Cdilform____ —cful100m1. (E 1 2 L LC Replacement Sample Required: 0 TNTC ❑Sample too old • A U G 21 2023 I -
❑ Sample Volume ❑Damaged Container ❑— — V
— Lab Reference Number By
Receipt Temp C-: aT COUNT/SM92220
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Date Reported AU6 0 6 a�`113 1 0e asnc""'w°�d.'you"in tapaA
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DOH Form 47713 �
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