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LAB ANALYSIS <br /> LAB 1 �r i g m.F..:"' it: <br /> F AT . N �)ll s q �y, <br /> 'LpLIFORM I 04/ 1hNA �i 5 ° �5Q�U^N' LOCAL HEALTH DISTRICT' C¢WFORM FECAL COLIA4J QUAh1LQAIHEALTH DISTRICT' <br /> rt M "' Vii_�" ET P.O. Box 2069 �.raa F 1 1� '1�.Pi ll' P.O, Bax 2009 <br /> COMPLETED` SPL - 1601 E. Haielton Ave., Stockton, Co. 95261 COMPLETED SPC/Ml- <br /> 10M <br /> PCIML 1601 E. Hozelton Ave.. Stockton,.Ca. 95201 <br /> MPNn(1 , PNl10 M <br /> 10 ML SAMPLE PER TUBE 10 ML SAMPLE PER TUBE <br /> GAS IN HAS t z 3 4 5 WATER ANALYSIS -< WATER ANALYSIS <br /> GA5)N HRS. 1 2 3 4 5 <br /> PRESUMPTIVE z4 Address All ;r)quiries To Address All Inquiries To <br /> as DIVISION OF ENVIRONMENTAL HEALTH <br /> TEST 24 PRESUMPTIVE DIVISION OF ENVIRONMENTAL HEALTH <br /> TEST <br /> CONFIRMED 24 OUTINE Cl REQUEST 11RECHECK 48 ROUTINE Q REQUEST Q RECHECK <br /> TEST48 ❑ PUBLIC ❑ PRIVATE ❑ Drinking Water CONFIRMED 24 ❑ PUBLIC ❑ PRIVATE /Drinking Water <br /> TEST <br /> FECAL COLI 24 f's ❑ Raw Surface ��,I ��; f1/� 48 ❑ Raw Surface <br /> Water u � VID 4"4�`'°'�'I& n ( - Water I] [l f -IUiTi_1 <br /> COMPLETED FECAL COLI 24 SAMPLING POINT ` 1 <br /> SAMPLING POINT I <br /> PHYSICIAN(NAME AND ADDRESS) ` COMPLETED (NAME AND ADDRESS) �^ { 5.� <br /> TYPE �Y 11 r f TYPE �riy f} �` � �d ` k h <br /> OR .r .x PRINT Vl �[}5� �� 5 Kitt he�"1 ,..� <br /> PRINT � `^) /( f � <br /> • "LJ3ff1! � V y <br /> SAMPLENO 2— O o SAMPLE NQ <br /> RATE&HOUR OBTAINER i f �j q I&HOUR OBTAINED •� <br /> LAB FO 9 SANITARIAN DILUTION fl <br /> 1JC..� '' t3V 4/ �C.J��. `.�s " •' i _ i SANITARIAN <br /> IT- <br /> ' >t <br /> 77 <br /> rk ., ANALYSIS .R t"!"46. � L >f� ri " <br /> FEB 23'00 12.16 DN LAB <br /> �� ANALYSIS LIFORM FECAL OLI SAN JOAQUIN LOCAL HEALER DISTRICT <br /> 2009 <br /> LAB T _ P.O.Box Stuc <br /> N FECAL COLI SAN JOAQUVN LOCAL HEALTH DISTRICT COMPLETED 1601 E. Hazelton Ave., Stockton, Co. 95201 <br /> ILIF RM p.Box 2009 SPCIML A <br /> PI 1601 E. Hozelton Ave.. Stockton, Ca. 95201 PN 1 ML WATER ANALYSIS <br /> OMPLETED SPC/ML t 10 ML SAMPLE PER TUBE 4 <br /> 10 ML SAMPLE PER TUBE WATER ANALYSIS GAS IN HRS. 1 2 3 4 5 Address All Inquiries To 4 <br /> *GAS IN HRS. 1 2 3 4 5 Address All Ingvlries To PRESUMPTIVE 24 DIVISION OF ENVIRONMENTAL HEALTHL <br /> 24TEST 48 )E7_ROUTINE 11 REQUEST ❑ RECHECK <br /> PRESUMPTIVE DIVISION OF ENVIRONMENTAL HEALTH <br /> TEST 48 ROUTINE [3REQUEST ❑ RECHECK CONFIRMED 24 ❑ PUBLIC P�PRIVATE "Drinking Water <br /> 24 t p PUBLIC �RIVATE 3KOrinkir Water TEST 48 ❑ Raw Surface ❑ f �r`- iw V L: <br /> CONFIRMED Water <br /> t TEST 48 ❑ Raw Surface ❑ FECAL COLI 24 ' SAMPLING POINT <br /> Water <br /> •FECAL COLI 24 <br /> 1 SAMPLING POINT COMPLETED <br /> ' (NAME AND ADDRESSI <br /> �jCOMPLETED F , <br /> TYPE !s / <br /> (NAME AND ADIORpR C/tf 4 I.^•L7S -5 <br /> TYPE t PRINT <br /> OR �l�r Qle `Q4 fnj (nil f, j r -e [.' f /i�r'•, r�/; ;:�,? - - - <br /> PRINT <br /> ([ <br /> AI/- { Dn{f[ <br /> t <br /> `T' I 0 o SAMPLE NO. <br /> ••�/} 85- <br /> ILL <br /> SAMPLE NO. - DATE&HOUR OBTAINED 'i <br /> ¢m ►�JtWI JV Ah <br /> ao <br /> O o OAT &BkiDUTca ❑❑O ' _ ; x.74 � ,• �" r I,�.; , <br /> aZ; SANITARIAN 4fly'JfA-V 1-l)4.D lam(%`I�lL17 <br /> SANITARIAN <br />