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ani <br /> �I 1 <br /> .�— UaONNTOpY USE ONLY <br /> C1 Jooctt r1 county San Joaquin County Public Health Laboratory <br /> UbllC1601 E. Hazelton Avenue <br /> Health Stockton, CA 95205 <br /> Services ELAP # 1892 <br /> Harm est Ka u r, Ph . D. LABORATORY NUMSER DATE RECFJYED <br /> n, vrcwm h , , , Laboratory Director <br /> phone: 209-jj46�8-3460 Fax : 209466-0639 <br /> Submyer lnlorrMWn -F--Y nlnronnatlon <br /> Agency: <br /> JC 1. ,. Sample LoSample Location l <br /> Address 111, <br /> Sample Point <br /> City State <br /> Name <br /> LpJ Street <br /> Phone number `— —� n v City tate Zip <br /> C <br /> Collected By Number <br /> Chlorine pH /O �� Q Sample Itlenhricabon <br /> Dab Specimen Taken : Ime <br /> WAITER P / OR T/ON <br /> otable Water ❑ Potable Water, Private (� ❑ Public <br /> ❑ <br /> Routine ❑ Duplicate Specimen for Compliance E3 Source other <br /> _ <br /> TEST(S) REQUESTED <br /> Total ColAomvt_ coli Qualitative (Coliten) - - _-�— <br /> FOR LABORATORY USE ONLY <br /> Set up Initials. Date/Time Started <br /> Reporting Initials Date/Time Reported : <br /> WATER TESTING RESULTS <br /> ❑ Total Coliform Absent (Colilert) <br /> ❑ Total Coliform Present (Colilert)' <br /> ❑ E. toll Absent (Colilert) <br /> ❑ E. coil Present (Colilert)` <br /> Water temperature (Batch) upon receipt (°C) <br /> I attest that all testing has been documented on the appropriate QC logs, using controls, kits, reagents and equipment that have met the San <br /> Joaquin County Public Health Laboratory Quality Control requirements. <br /> Analyst Initials: <br /> � � i -' t"� � batt Supervisor/ Senior InitiallDate: <br /> Updyp 0&= HK <br /> Positive results mqulrc er. <br /> " Batch is defined as : Any group of v, atcr - rririecs rccc_ „ed a . me 5zmc limc ona transported under the same conditions . <br />