Loading...
HomeMy WebLinkAboutSpecial Inspection Miscellaneous 2010-9-3 301 S'.!,-'ft Sf. .5Pf2-. W/fl- Dozo6 .. i'. .... ....... ....... . . lta ~':~~""\::='....~. =~:~b' .' . City, -CoUnty:. t:.inq.f'- () fJ . dar1.t. . Phone: S4l :~ 3:n;O Fax: .::fll...3!f::/. ':1'34$ PMbn 1Drnpart: '.. Name: J:{g Cons-trirlloYl.lnc. AddnlSS:.PO Box. 2.L.\3""Z.. . city, state, ZIp: 7..- Sample Collect8d Dat8IT1me: t!;-' p:;z.,.2!2!!2 -C0l18Ct8O By:'- .- '.- . '... ... DISTRlBUTlON Seniple Type: 0 Routine 0 *Repeal . 0 Temporary Routine "Date of Initial PosltlV8: I'. J . ..' "OrIginal PosilivelO#: ... 1 "'jjjj""'1 YY'iY Address: old.~ ~((y M~U . Samp18dat(os."SINK"): SOURCE Sample Type: 0 *Triggered a *Confinnatlon a Assessment . . . "Date Of Initial Positive: I 1 ""iii""/""'jjjf'"/YYYV OREL.APtI: OR 100024' . Lab Name: Delta ErlVironrnental Services Address: 105 E. Hilliard Lane Eilgene,OR 97404 phonelFax:(541) 689-3177/(541) 689-5104 BolIIe#: -B 1 e . Special, tJ SPecial . *OrIginal PoSItIVe 10#: sOurce ID: SRC- Source name (ex. ~ lJ1~): '. CortJ$16P' ~~~~." LAB USE. ONLY .... ... . .. Safuple RilceJv8d riat8inme: .Q:liQ:Z.,l~ Q1;W /tS'AM . Initials: 'Terilp:~'C. Mil 1 DD I YYYY Hour: 1110 a PM. Evidence of coOling?' YeS'a No . Analysis SfartDale111me: -1-1 .3::...1 ~ 0'1 : ~ itAM Initials: S-P IIlI. 1 DD 1 YYYY Hour: MI. a PM ORELAP.1"l ColUert8 . a Colilert-1e" I:J ColIsu",8 0 Chromocu~ a CoIlscanB. I:J Rea.' dycult'" Method{s): . ........-_. I:J 8M 9221 B (MTF) + a.E or 0 F 0 SM 19"' Ed. a SM ZO"' Ed. I:J SM 21" Ed. . a SM 9221 D(P.:.A M) + a E ora F I:J SM 9222 B (MF) + a 9221E or .1:J9221F or a9222G I"l SM 9223 0 ColITagB 0 Mlagar 0 m.collBlueB I:J Other: R . .'Analys. ' .IsTI..~ IeteDate~B:.!L15 I~ .a:t.:=s ';;tAM ::I:~: I:J Present . ~sent~~.@/;II 1 DD IYVYY Hour: IIIn . 6 PM . Eo CoIl: ..... 'AbllBnt-- uRe1llBwb)r.~ . .'. u . ... fE..i.a::t:.i "'LOl "1Ill--1 ., DO'" t. yvyy... Reported By: Salllpleln\r.lU"k!n: . 'o'OI/8r.30"hours-:'.. co. o'Leilk .:" ,. .'.,..' a H.,wy non-collform growth a OIlier DHS USE ONLY ReportDate q I~I 10' . . __I DO 1"WYf . Test RlSUIIs l1lIl!luonlY1D the ~ l8Oted'~11d to.the lI8II1pIea .. ~by the .IBboraIory' Teal_meet ell requI"""'-'is 01 . ~ELAC ...i8ea Cihe.wia8 nole<l'.TI1b ~.~ ~~'~': exaipt In rUl. WIthOut w.m.;, Coneerit 01 ti1Ia 1a1x>rliiii!Y. Send.- ' toDH&mVP p.o. Box 14350. PerII.end. ClRt729U380., .' .' . For tecmrlcal suppor1and inIimnI!tion, pl_ call.Data Management CoOrdinatDr (ph, 97Hi73-04llS, M-F, 811111-Spm PT) or visit hllp:ltwww.megon.govIDHSlpbldwp/labs.shbnl 1 lOOO/TOOO ~ UOll::>n.J:J.suoJ r~H LS'SS6S9ns XVii ZO: 9T OlOZl LO/60