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BACTERIOLOGICAL ANALYSIS <br />Note: All applicable information must be supplied for compliance credit. <br />Pace Analytical Services, LLC. <br />205 East Meadow Rd, Suite A <br />Eden, NC 27288 <br />Phone: (336) 623-8921 <br />Fax: (336) 623-5878 <br />Water System Number: <br />Name of Water System: <br />NC --County: <br />System Type:Water Source:— OR —Distribution System — Revised Total Coliform Rule (RTCR) <br />Sample Type: <br />Facility ID: D01 <br />Routine (RT) <br />Sample Point: <br />Source Water — Ground Water Rule (GWR) <br />Sample Type: <br />Facility ID: <br />Triggered (TG) <br />Collected — BY:DATE:0 9 / /21 42 TIME::01 ,03 ma <br />Mail Results to (water system representative): <br />Yadkin Well Company -David Brown <br />1908 Hamptonville Road <br />Hamptonville, NC 27020 <br />Phone #: <br />Fax #: <br />Responsible Person's email: <br />davidbrown@yadkinwell.com <br />33 6 <br />Repeat (RP)Special / Non-compliance (SP) <br />Location Code:Tap Location:Well Head #2 <br />Routine Original (RTOR) Repeat-Original Tap (RPOR)Repeat-Upstream (RPUP)Repeat-Downstream (RPDN) <br />X <br />Additional/Confirmation (CO)Assessment(RT) Triggered/Distribution Repeat (TD)* <br />* for systems with a population < 1,000 <br />Sample Point: <br />864 44 4 0 <br />Complete for Repeat, Triggered, or Additional / Confirmation Samples: <br />Previous Positive Laboratory ID Number: <br />" Positive Laboratory Log Number: <br />" Positive Location Code: <br />" Positive Collection Date:// <br />Disinfectant Used: <br />Total Chlorine Residual (chloramines): <br />Free Chlorine Residual (chlorine):mg/L <br />mg/L <br />Street Address:Chapel HillCity: <br />Check ( ) if sample site is owned or controlled by water system. <br />Check ( ) if sample site is a daycare or a K-12 school. <br />Laboratory ID Number:3 7 7 3 8 <br />CONTAM <br />CODE <br />3100 <br />3014 <br />3002 <br />3028 <br />3013 <br />3001 <br />CONTAMINANT <br />Total Coliform <br />E. coli <br />Enterococci <br />Coliphage <br />Fecal Coliform <br />Heterotrophic P.C.3 <br />METHOD <br />CODE RULE <br />9223B <br />9223B <br />GWR <br />GWR <br />TCR <br />RTCR/GWR <br />RTCR/GWR <br />RESULTS <br />Present 1,2 Absent <br />X <br />X <br />1If fecal, E. coli, enterococci or coliphage is present, lab must fax results to the State on day test completed. 2If total coliform bacteria is present, lab must fax results to the State <br />within 24 hours. 3If HPC is absent, enter a "0" left of the "cfu/mL or MPN" units; if present, enter a whole number. 4Explain invalid code below in comments. <br />cfu/mL or MPN <br />Analyses Begun — DATE: <br />Analyses Completed — DATE: <br />p900 m44//42 612TIME: <br />4/20/9 31 <br />: <br />TIME:1 5:m5p2 <br />, <br />, <br />(Date as: mm/dd/yy) <br />(Time as: h:mm am/pm) <br />Laboratory Log Number:92753076001MBIO Certified By:Jessica Mize <br />COMMENTS: <br />Invalid <br />Code INVALID CODES: <br />1 <br />2 <br />3 <br />4 <br />5 <br />Confluent Growth / <br /> No Coliform Growth Found <br />TNTC/No Coliform Growth Found <br />Over 30 Hours Old <br />Improper Sample or Analysis4 <br />Turbid Culture / <br />No Coliform Growth Found <br />Repeat Samples Required from Client Resample Required from Client <br />NCDEQ <br />Public Water Supply Section <br />F-CAR-CS-022-rev.01, 8/3/2016 <br />2016 <br />Rigsbee Well #2 <br />Orange <br />Hwy 54 <br />Kenny Reavis <br />48