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�--------------------------------------------------------� <br /> DRIN14AfG WATER MICROBiAL 8A�lP�.E COLLECTIO'rl , <br /> d�LABORATORY REPORTlNG FORMQ7 � �.-r:,� ��;�;:•:��.-c,r Pt�-'rro��:t:.t+�:y=•�e ; <br /> �6�01 Soutff�olnt PkwY.•.mckaolwNle.FL 32218•904.303.99b0�Fax 904.383.8964•�374 � � <br /> ❑eStS SW Art�r Rasd•C,�b�esvlAe�Fl 3�08�3b2.37T2349•Faz 362.895.Q839•EAZOM � � <br /> 0 10Q00 U9A Today Way•Mkarrur.F1.3302b•951.889.2Z8B•Fau 964.889.2281•El�58S ; � <br /> 0810 Pdnc�ss Pafm Ave.•Tempa.FL 39619•813.63Q.�846•F�c 813.69�.4327•Ed160! ; ,�q ; <br /> 528 S.NoM tak�Blvd.,S`te.1018�AMamonts 3pritgs.Fi.92701•407.937.1584•E3s078 � _ •''^� , <br /> �-----�------�------------ -------------` <br /> , �.. . <br /> ��9�i�C�r1i ��w�a-rm�s: !� <br /> � R � s �a�ari�s �nc. ��.:� �Q � �� � �.�. � �� S <br /> �A�►iro�m,� ai ��� , �.�,.���� o��,,� �.� <br /> �� � o� <br /> �-r .�-.� n,�.s.mpls ao..no�m.d nb wrowrq rovuhe�+ts: <br /> Report Num . Suk�Contract Lab 1D: <br /> Rsqussbd:(check all ihat ePP�Y) <br /> Tdtal ColiForrNE.� �Tofal ColiformJFecal ❑Er�taroc�oci ❑CollphaQe ❑HPC ❑Other. <br /> PublicllVaMr8ys�sm{PYVS}Nams:,,��.� �L-���1�1.2,�� -- PV11Sl.D. ������� <br /> PWS Address• ��� D�Y�T�� <br /> f'WS or PWS ?s PFwne#: � " Fax#:�G�� �'�'-.._l�:C1S <br /> Coflaetor: � .�NAJi=� _ CollecEofs Phone �� . `rJ � <br /> T ot 8upply:(cheCk ddyy oney <br /> munily WsEer�ystem ❑Non-Transient Non�ammu�n,yWa�er Syatem �Translent Non-community Water System <br /> . itea uee syecem OBolnea wetsr ❑Wlvate weN Dswtrriming Poo1 ❑ar,ar: <br /> tE�son tpr s.mpnn0:(check a��thac er�r) <br /> �p�butlon Routine ODfsM,bufion Rep�d ❑Rew(triggered or aosessrneM) ORaw(tti99ered or essessment)addidonel ❑Well 5urvsy <br /> Cfeelrance ❑Replace t(elso chac:k of sempie bsing replecad) ❑Boit Water+Notice ❑Olher. <br /> S�m�le��ofbr.ilon Oats• "� oc►�e:raaora �o��s.Re�..d oawv+o <br /> ^.�'�"i�`': "wl�.��"�:4=� ne'`M" i i !i ."r�'..:".'+S�ffi'.m�,"*.�.`+►�','�'i^« �x`�C; _ •i.x*:• <br /> ,,. _ .�� a.in- -��/�naiY+�n�an,oa(s)' ;�'��,,'�t'�C,Z'L,�'� <br /> SamP� {L.ccatlon a 3�P�I �) ��� 1YPB' R�eMual PH Nork TaP1 Fs6srcoocG,a � �la � <br /> (m9R) ', Cotllenn Cdlfortn �. �uaAAir � <br /> ~� i���'' �3=�a � �. .� ,� v�� � <br /> � �c:���. � <br /> .� <br /> � <br /> .� � <br /> •i <br /> 1 <br /> � <br /> I <br /> ( .I <br /> 4 <br /> .�1r*i�pp cjf . �k.rli ud�ipr d1litAbutlon�routlno 3 reP�t G? . <br /> iairij�Ms. �orine'orTOtal chlorine(drele ohe}. O I Ur�ees otherwfae noted,ell tpsbs are prefonnecJ in acoordanoe wlth <br /> N�LAC sta�dards,and Itie r�ults relate only m fhe asmples. <br /> D I�t 1�Idw!AtiNyais M�thod: <br /> DPD'Coloitlrief�ie [�Olhqr: C�Ee and UrqBr P4VS notlfled by fab of poeitlw reeuMa: <br /> P���Aqrminp olsi. nt ��; on�of hdow): <br /> Dabe snd ffine DEPlbOH nWHHd by leb�of poddve rssuke: <br /> �''A tz�lfllf4d t�P4�.(� �:����') Dabe Repart ledusd: <br /> �78u�SrrMptl bY cert�d q�rstor(M- .: , _ � ) � <br /> ❑�in�loyed bYe�rt�d�ep"T�Employad by DEP or DOH ��ro: �� �� � �'�— <br /> ❑NuthoAasd roprasenmtive oi su�bt af waEer TNIe: . � :��� �. <br /> '�•S'':'f`.•'•'�c' ., `�y��.'• . .._)D'' . Q_ �':�O•-T( �1::".' .r,� P.,r DEP/DOH USE ONLY <br /> ❑Sitll�.7bOry <br /> .�r T � C, � •�C� .�'����-5 ❑.anc«►�pl.oe.cor.affon�Ma�naHor, <br /> � ..C}1ieP�t Samp�dlieq�frotl <br /> .�–J 3�_� �'��'j. ��s.�o�es r�ewwea <br /> Dete RaMiswed by DFP/DOH: <br /> ��,�v�?�5.. �L 3���� o��.��: <br /> ��a,�.a�si.00�!er..r�..�r.�.e.� e�p.yr.me....:c-owe�enw+�•��'. Ralinqulsh By: � �GV Date:��t�"��Time; <br /> ;.q�IMIC1�yL R�Rii.N.E 4 Pd4 d GY1r4fir4 P.PI/d 714,8.lpdd AMN1M.��. . <br /> U�� <br /> ►�.�:�o:�rtr.m�e�aewra;�oou'c:�e.ase+r <br /> Reoeived By: Date• 1 Time: �Cl Y�' <br /> Pu...a�er wrow., <br /> 4��.+ti +�4+w�M�t�1m'.sa.xn.iYer,� <br /> Cw�Y�1or4.�nui`9 noN�'si'�i rva�cp�r�u4ri�Miu t'.rMrO OeP���Y b rn01�Y UOD.Do Ie1M��wv er pwil�pY�N T�we.rM <br />