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MICROBIOLOGICAL ANALYSIS Coliform Reporting Form for Public Water Supplies Oregon State Public Health Lab PWS EPA ID OR00023 PWS Name 3150 NW 229th Avenue Suite 100 Hillsboro Oregon 97124 Phone / FAX 503-693-4100 / 503-693-5604 City County Phone Fax Return address for report Name Bottle Address City State Zip Lab Sample ID Sample Collected Date/Time / / MM DD AM PM YYYY Hour Min Collected By Routine DISTRIBUTION Sample Type Repeat Date of Initial Positive / / MM / DD / Free Chlorine mg/L...
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