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WATER SAMPLE INFORMATION FOR INORGANIC CHEMICAL ANALYSES
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w. oATF RE aTe ILLEMEo Ca1ECrao ev.MMBFR
avarEY Lo.No. ers,— are+EY CLASa couxty
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80URCE TYPE anlmCE IP agIRCE I.wE M mREAM ENTER NAYE
WAI (WWI xea FEES ARE CHARGED FOR CHEMICAL TESTING
�.Spero -1 per. —_ A lee schedule Is available from this department.
T18 9AMRE WM LANFN F aAWLe WAS DRAWN FTW patRbamN SY.TEY
IT WAS MLECIED FRCP SYSTEM AT:~We) PARTY TO PAY FOR FEE FOR SERVICE TESTING
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IF TAKEN AFTER TREATMENT WAS R—FILTERED _FLUORIDATED elpmMaapuYaR (NIIYF11I WmAl Aee.aN
CHLORINATED _WATER SOFTENER: TYPE USED—
REMARKS: �]
(Water Aue lY pro ems. address or a Nona Dope.. eta A1111 / ��• I�'C 1-%JJ�O
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LABORATORY REPORT
LE�� m0 xor Y,mre amAW nro LEIm
TESTS - W& 1NAN IZs11Ln uNRa p •
< .Es No •E+IALs
kwic oAeP L U • O U_ mg/I (✓ � _ mil '
Barium IA' • "to
Cadmium Y OAP G C7 Q U a mvn Q LABORATORY SUPERVISOR
— aWIWWYu.YI
Chromium aoe' .-4— P •--C2 / 0 mon
Iron rda -I—
Lead aoe" — —� O �. emn CHARGE:( (.. '�
Mal,p"__ OAe • 0 -am/t �0 V
V REMARKS:
Memory Ar .o=, • �/ . Iron t ✓.
SellXan.
Silva N 0m• L Q_• d . l Avon
Sodium
Haiti A87C.90
Conductivity 700 --- MbolehMYma /) 4l�AJ'r(� rJp �O.r
va•c
-Turbidity ta' --=•
Color IeA --�•— `� '
wit. J
Fluoride 1 2.0• < O • am/I V
Nitrate too' • mvn ✓ L.I•-c.c/, _
Chloride 250 .
Sulfate SA veo -
TDS
Copper 1.0 .� • a over.
Zino Y e.0 L• • N/I. P V • I� -
�Y0. Y We
Yatllws Canlamlun MN AEFM 'PYMry N.W! ,r
sett aln Ave'seaaS w AY1 AAAOptLasomtarya pate PreDaMalO Copy '.'DOrlemala Eaw WYpauoalp EDDY WIOCIESpInap OepY Lpal Walth Depl.O
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4 1 ,ATATE OF
DEPARTNENT OF HEALTH t `
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J WATER BA'CTERIOLOGICALANALYSIS
SAMPLE COLLECTION: READ INSTRUCTIDID6A8 PACK OF GOLDENROD CPPY
If Instructions are not followed, sample will be rejected.
DATE COLLECTED TIME�rjOLLE^CTED COUNTY NAME
MONTH DAY /1YNR A yPDQZf
SVP OF SYSTEM IFPUBUC SYSTEM,COMPLETE.
I 0 IN LD. No.
30778 I CLASS i
❑ INDIVIDUAL 1 2 3 4
,..a.�n '
NAME OF SYSTEM
llgtw, Han7a 001Wa�cL
�. SPECIFIC LOCATION WHERE SAMPU OOLV4T�O S'(1 q.Wwm4w NMIE/WD TFIEAbNE NO.
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-
SAMPLE COLLECTED BC IN.I!RXK^ IM,Ri Mrn»;, t• lit
Ann lh 3
SOURC,ETYPE r RN`rErRl'MNBE�"
O'SVRFACEH0 WELL'=LB'EPRrtmti E`Y ORCMAUEV4(•]_CONT INATION
or0 HER
.. .-SEND PURE TO:(PIRt Full N.myy AEE ryy w zp txK Mn"%• •,Ir- -
-' /t Yl-14
t./III 1•"' wAaB xDT01i �55
TYPE OF SAMPLE nMG
F WY omnwZ.) - ✓tAR'.:}Yv'CI •fe N� ...
T. kDRINKING WATERI ❑CMP�EBIBd(RBBTBU4F'-P.�YT241_Free)
<Mck Irutmenl--1 ❑ FlltarM .';� - ' <
2. ❑ RAW SOURCE WATER
QeWOMR[bTY E-`al4�"II1IMi4-
-3. ❑ NEW R(SWICONISTRUCTIONfor REP(UI, '.ABTePAll" PFA
d;0 OTHER(SWIM "..1 ,lyuc x. •iTex 4r'.tb
COMPLETE IF THIS SAMPLE IS A CHECK SAMPLE:'e-P'• '�} •`
PREVIOUS LABNO. U T3i9Y -
-.PREVIOUSSAMPLE.COLLECTIONDA �•
REMARKS:
iI w
I LABORATORY RESULT APR LAB use ONLY) 'e
I C7yFJJ M 7 SIT)PLATE COUNT S�AMPLE
RE AUSe NOT TESTED ,.
E��/--i-� ^ ' �Q! 'F • TON 3JAAA�•.
MPNOILUTIOt4, TJ:STUN gYu T RCS�fmN L-I ,-P1a TO Old'
r
IRA r.. v. r
400W 66 0 t7wdecY�n"Pso�d7.08Mehler�l.
MF COLIFORM 2 L1 TNTC - ❑ Ineulllelent InlormAtlon
.. /OO - P"Ided—Plelee Read
3 ❑ Eleeasf0e0r1 Inelruatlo
. ne on Form
FECALCOLIFORM n. FJ{N• �',V( ITPJ,
ail 4. [3
❑r -
FO RIKI NNGWATMPLES ONLY.THESE RESULTS ARE:
SATISFAC ER SA
TORY1. ` IT UNSATISFACTORY
SEE REVERSE SIDE OF GREEN COW.FOA EXPLANATION OF RESULTS
LAB NO. DATE TIME RECEIVED— RECEIVED BY ')
w
DATE REPORTED LABORATORY.. - -
' REMARKS � J DOH MISGIM(REV.r1.1R , .
I
WATER SUPPUER COPY mL