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008252250 SURVEY
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008252250000
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008252250 SURVEY
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Last modified
8/4/2020 10:35:29 AM
Creation date
3/28/2011 2:34:22 PM
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HealthDept-Rural
Pin no
008252250000
Box #
136
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(�� 11090098 - - - -� ROUTINE ' <br /> L" f A I RFAX COUNTY FEN_TN DQ'ARTIElIT lJ1BORATORY - BACTER 1 OLOG 1 GN E 101 LAKE, DRIVE M12 <br /> A-4- -3 r+. F EX0005060 ELCHD <br /> rH <br /> SPACE BELI <br /> DATE REPORTED f IIIIIIIIII �I II III, I II I II IIIII�IIIIIIII o�', <br /> < TIME COLLECTED / CITY OR j <br /> DATE COLLECTED J - - ul COUNTY L04' ' p <br /> COLIFORM ABSENT <br /> p SUPPLY OWNED BY GC; I Gc GT �1� w L1 MEMBRANE FILTER COLIFORM PRESENT <br /> � // J/ W FECAL COLIFORM ABSENT <br /> ~ <br /> LOCATION J [�/ /�,,',> � -ftPQ 2,7 y D PRESENCE- ABSENCE FECAL COLIFORM PRESENT <br /> i PREVIOUS SAMPLE TNTC,CONFLUENT GROWTH2OR TURBID _ S W <br /> 0 <br /> < SAMPLING POINT k; �cL,�� U HETEROTROPHIC PLATE COUNT /100 ml <br /> Z IS SUPPLY CHLORINATED? _ YES _ NO a <br /> v CHLORINE TEST MADE AT SAMPLING POINT? _ YES L '10 ~ D FECAL MEMBRANE FILTER FECAL COLIFORMS /100 ml <br /> RES -CL. PPM COLLECTED BY (�fe Y 0 Ilk. <br /> m REPORT RESULTS TO: = DILUTION MPN G 0 COLIFORMS /100 ml <br /> U <br /> L-0 I� Ct O - (D �C'c�f l I � � U FECAL DILUTION MPN L oZ ` (� FECAL COL I FORMS / I ! <br /> a <br /> �' _ UNSATISFACTORY (PLEASE RESAMPL.E): <br />
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