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I SIAIE OF CAtIFOQNIA DEPARIMENI OF 1UB11C/IEAl1H Date Received ; lob. No. - ----- -- -- J- ---- <br /> SANnAIION AND PADIATION LABORAIORY - l <br /> BRANCH PUBLIC HEALTH IABOQAIORY <br /> -' Blank <br /> SAMPLE FOR CHEMICAL ANALYSIS leave Serial Number <br /> Purveyor and Address (Include city and county) System Number8 54 <br /> Serio <br /> SamplinL g Point Collected by Dote and Hour Collected - ----- --- <br /> t �"YeL- Io . C. bolz�u►E.•� i2-z,2--7Z <br /> r- OW DWR [+Drinking Waters ❑ Row surface waterSend Health CMIlcor Type of ❑ RawTradeReport BSEJTICJ <br /> ❑ Owner ❑ Dept. Fish& Game ❑ Other waste <br /> To: Sample: [3 Treated --- ---- -------- <br /> ❑ Bur. Contract Services Other(specify) <br />_— Other (specify) El <br /> ❑ RWPCB # ❑ Sewage: ❑ Chlorinated <br /> Check analyses desired - Results are expressed as mg/liter Other specific analyses desiredl �.- <br /> -__ �Y6lot Dissolved ? ❑ ClSolids�• Ca <br /> m I as CaCO, zMg f C�5150, � � t <br /> Hord. <br /> ❑ Hess (� 1 C:) F <br /> C3HCO,�_ Tso,.l - - — - -- --. <br /> L= moo, - <br /> No ❑ PH m 0r.CD �AQAP A <br /> ❑ /73 <br /> OH <br /> ❑ K ❑ y l <br /> L I Alk. <br /> 0 ABS— 0 Grease <br /> ❑ PO. ❑ Suspended Solids ❑ Date Reported Analyst <br /> --- ❑ BOD ❑Setileable Solids 44,73 �� 0� <br /> LA ml/I/hour <br /> • I <br />