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08l2512012 14:44 (FAX) P.002J002 <br /> DRINKING WATER MICROBIAL SAMPLE COtLECTiON � � ��-�-����-����-��-�-����� <br /> & LA80RATORY REP�}RTING FORMAT ' <br /> Wrlte Project#or Pieoe ProJect Lebel hlere <br /> Q 6801 Soutt�pdnt Pkwy.•JalloonviW,FL 3R218•004.983.l350•Fsx 904.]6:i.9354•E04S74 <br /> �88158W Ar�rl�d•ti�kwivllls,FI 32�•352.971.Z3�a•Fo�35R.395.6680•E�2001 <br /> 0 10200 USA Tady W�y•Mkartiar.PL 33025•934.beP,?Zea•Fex 95t.60p.22E9-E!?67� � <br /> ��G1p Princ�c Pdm Aw.•Tsmpa.FL 3�81 B•813.a30.9B16•Fsx a13.d90.4321•EMdM ; � <br /> p 626 S.North ls lu Bfi+d..�e.1018•111�monl�Sp�Uips,FL 32701-107.937.1304•!6]Q7! � � <br /> Rdvanced �+Re�►n�a a nme: L� <br /> E�Yiro�meatal �abo�atories, I�c. ��°��8r�: � � <br /> S�rnpi�Aep�pqllp C <br /> Sai�pM ProservaUorK C�'Qn leo pNol On la C��'C <br /> � DINMachnt Ch�dr, bsE�cYsd$a <br /> Report Num ber: S uQContrect Lab ID: Thh S�npl�do�s ' ma�t ure Twawing NELAC requlrsrn�nm: <br /> Analyal�Reqwst�d:(check alt that spply) <br /> �otalColliom✓E.r�nli QTotal�CdibrtnlFeral ❑Enterocacd OCoNphage ❑HPC DOfhar. <br /> Publlc WaE�r Sysbm(PWS)Nsms: l,.� 6�GLOIr,liX/tl ifs PYY81.D. ������� <br /> PWS Address: �,�5 �J7► �� Clty: <br /> RINS or PVVS O�p�'�Pr�e#: - a^ ocaDB Fax 1M: - — � <br /> c�a�: J�,a�tla�, � r nn � con��rs w�«,e�: <br /> �T p�d SuPply:(chock only one) <br /> Gommunity WaW System ❑Non-Trar►elanl Non-communHy Waber System OTranaenl Non-0ommunity Water System <br /> pLlmiled Use Sy�fem ❑BotUed Water DPrlvste we11 pSwMwr�ing Pool pOthsr: <br /> RNSOn for B�mpNno:(eheck ell ihat apply) <br /> pistributfon Routlne ❑OisMbuNon Repeat ORsw(trlgpered or as�asament) ❑Raw(trlgpered or assassment)addifbnal []Well Survey <br /> rsnce C]Raplacement(also check type of semple being replacad) • ❑BoN Weter NoUce ❑Othar: <br /> 8�mp1�Collaellon R�Ee: ��.y��a ocw:w�as Ee.ew.mAS.a.a..a odoano <br /> ,:,s�., <br /> • Oi�k► �MY�M�thod(s)' A � �� . <br /> Semple Sampls Polnt ��� Swnpla isidaM �'�J <br /> # {Locatlon or 5pedfic Add�ss) Tima TYPe RsMdual � No�- Tatd Fanl.E.aoY, wp Lab <br /> (mpll) Cdiform CoNfartn �°0�i°f Quelqi�r• S�*ple <br /> 1a S . sf. �, , � <br /> Awrp�ot rMWwls for dktributlon►autiy R r�st � <br /> ssmplea. �ar ToW clNorir�s icYds au). D� Unkss othervvise noted,sll tests are prolonmad In accardance wttl� <br /> nlrelant R�sldud MN�rsb Nhlhod: <br /> NELAC•stande►ds,and the resuNa relele only to tl�e samplae. <br /> OPD ColorGnNrie ❑OMisr. Delo and Ihns PW5 nolilied by leb ol posNhro resulb: <br /> P� on p�riormNp disb s sls 1�(Ch�eic on�of b�low�: [Me end tlms DEPlDOH noliied by ieb d poslqve rssuQS: <br /> �A wrlMbd oMnlo►(1R� ��Q � Date ReP�Issu�d: <br /> �Supsrvl�ed byCSrtllfad opKato►f,k ) <br /> ❑Employsd by�ceAlEed leb ❑Employed by DEP or DOH Lab Sipnaturl; — <br /> ❑Au�fzed roprasontatlw of iupp�ier oi weter TJdl: <br /> ilTtS�T HAM£AND ddAlUnO ADbf21;9S pF PhRSON T'O ABCEf VE RBPQIt'TJ O S��y DEPIDOH USE ONLY <br /> �(�'L�O� ���1 t'S O fneomp�sls Ca�p�et�on Iniortiwlbn <br /> �3�� g�. �-�, o��,�P��� <br /> D�la Rwfewsd by OEPIOON: <br /> �� 't s y � DEP/DOH Reviewinp 011lelal: <br /> i <br /> kr.w..wi.hr.b...d�.�.i.ow.u,a..uwwv•n.ao-oraw�o�•��•�. Rellnquish 9y. Date: T�me: <br /> R�./dwek R�l�w,N.�y Iiit b0Y16Aon,P�lYNTip A.fp.ell(dw�u.ye} <br /> �.aw�me a RMSS.nm aora��ua;�w�arw.e�me:�wo-wn�ee ReCelved By. DaEe. �I Tlme:�� <br />