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Document 2129160
Attachment No. 1 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Microbiology Analysis Sampler: Albert Hatzenbuhler Sampled: 04/02/13 Received: 04/02/13 15:18 Reported: 04/08/13 RESULTS 1 Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13D0231-01 13D0231-02 13D0231-03 13D0231-04 13D0231-05 13D0231-06 13D0231-07 13D0231-08 13D0231-09 13D0231-10 13D0231-11 13D0231-12 12:00 11:30 10:08 10:23 10:38 10:51 11:15 12:14 8:51 9:48 9:26 9:14 1771 Valley View Ave 279 Oldenburg Ln 3378 Corydon Ave 2309 Alhambra 4356 Old Hamner Rd 3424 Valley View Ave 217 Mt. Rushmore 2575 Three Bar Lane Well 12 To Waste Well 13 Well 14 Well 15 To Waste 0.50 0.60 0.90 0.90 1.30 0.90 0.70 0.50 A A A A A A A A A A A A A A A A A A A A A A A A <1 <1 <1 <1 <1 <1 5 15 7 [1] 50 3 <1 = Analysis performed outside of recommended 8 hour hold time but within required 24 hour hold time. Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Microbiology Analysis Sampler: Albert Hatzenbuhler Sampled: 04/09/13 Received: 04/09/13 11:50 Reported: 04/12/13 RESULTS 1 Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13D0818-01 13D0818-02 13D0818-03 13D0818-04 13D0818-05 13D0818-06 13D0818-07 13D0818-08 9:46 9:30 10:20 10:30 10:36 10:54 9:15 9:59 1771 Valley View Ave 279 Oldenburg Ln 3378 Corydon Ave 2309 Alhambra 4356 Old Hamner Rd 3424 Valley View Ave 217 Mt. Rushmore 2575 Three Bar Lane 1.20 0.30 0.90 1.00 1.30 1.00 1.20 0.30 A A A A P [1] A A A A A A A A A A A <1 <1 3 <1 <1 1 <1 6 = Notified Terry 4/10/13 0830 Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Repeat Samples Old Hamner Sampler: Albert Hatzenbuhler Sampled: 04/10/13 Received: 04/10/13 12:05 Reported: 04/12/13 RESULTS Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13D0984-01 13D0984-02 13D0984-03 13D0984-04 13D0984-05 10:25 10:30 10:35 10:58 10:49 4356 Old Hamner Rd 4324 Old Hamner Rd 4355 Old Hamner Rd Well 13 Well 14 1.30 1.20 1.30 A A A A A A A A A A <1 <1 <1 29 10 Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Microbiology Analysis Sampler: Albert Hatzenbuhler Sampled: 04/16/13 Received: 04/16/13 12:35 Reported: 04/22/13 RESULTS Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13D1311-01 13D1311-02 13D1311-03 13D1311-04 13D1311-05 13D1311-06 13D1311-07 13D1311-08 9:31 9:55 10:46 10:37 10:25 10:58 10:15 9:21 1771 Valley View Ave 279 Oldenburg Ln 3378 Corydon Ave 2309 Alhambra 4356 Old Hamner Rd 3424 Valley View Ave 217 Mt. Rushmore 2575 Three Bar Lane 0.90 0.70 0.90 1.00 1.30 1.00 0.80 0.70 A A A A A A A A A A A A A A A A <1 <1 <1 <1 24 <1 <1 <1 Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Microbiology Analysis Sampler: Albert Hatzenbuhler Sampled: 04/23/13 Received: 04/23/13 12:22 Reported: 04/26/13 RESULTS 1 Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13D1818-01 13D1818-02 13D1818-03 13D1818-04 13D1818-05 13D1818-06 13D1818-07 13D1818-08 9:49 9:13 10:24 10:36 10:44 10:56 8:55 10:02 1771 Valley View Ave 279 Oldenburg Ln 3378 Corydon Ave 2309 Alhambra 4356 Old Hamner Rd 3424 Valley View Ave 217 Mt. Rushmore 2575 Three Bar Lane 0.90 0.80 0.80 1.00 1.30 0.90 0.80 0.40 A A A A P [1] A A A A A A A A A A A <1 <1 <1 <1 35 <1 <1 8 = Notified Terry 4/24/13 0900 Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Repeat Samples Old Hamner Sampler: Albert Hatzenbuhler Sampled: 04/24/13 Received: 04/24/13 11:35 Reported: 04/29/13 RESULTS 1 Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13D1947-01 13D1947-02 13D1947-03 13D1947-04 13D1947-05 10:41 10:46 10:53 10:22 10:07 4356 Old Hamner Rd 4324 Old Hamner Rd 4355 Old Hamner Rd Well 13 Well 14 1.30 1.30 1.30 A A P [1] A A A A A A A <1 2 4 15 51 = Notified Terry 4/25/13 1215 Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Repeat Samples Old Hamner Sampler: Derek Lacombe Sampled: 04/25/13 Received: 04/25/13 14:37 Reported: 04/29/13 RESULTS Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13D2073-01 13D2073-02 13D2073-03 13D2073-04 13D2073-05 13:54 14:05 14:14 13:20 13:39 4356 Old Hamner Rd 4324 Old Hamner Rd 4355 Old Hamner Rd Well 13 Well 14 1.30 1.30 1.50 A A A A A A A A A A 3 <1 <1 1 4 Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Microbiology Analysis Sampler: Derek Lacombe Sampled: 04/30/13 Received: 04/30/13 13:25 Reported: 05/03/13 RESULTS 1 Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13D2285-01 13D2285-02 13D2285-03 13D2285-04 13D2285-05 13D2285-06 13D2285-07 13D2285-08 11:10 10:50 10:00 10:20 8:05 11:20 10:35 9:15 1771 Valley View Ave 279 Oldenburg Ln 3378 Corydon Ave 2309 Alhambra 4356 Old Hamner Rd 3424 Valley View Ave 217 Mt. Rushmore 2575 Three Bar Lane 1.00 0.60 0.60 1.00 1.30 1.00 1.00 1.00 A A A A P [1] A A A A A A A A A A A <1 <1 <1 <1 10 <1 <1 <1 = Notified Terry 5/1/13 0820 Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Clinical Laboratory of San Bernardino, Inc. Client: Norco, City of Contact: Bill Thompson 2870 Clark Avenue Phone: (951) 270-5607 Norco CA, 92860 Fax: (951) 735-0186 System: 3310025 Project: Microbiology Analysis Sub Project: Repeat Samples Old Hamner Sampler: Derek Lacombe Sampled: 05/01/13 Received: 05/01/13 11:40 Reported: 05/06/13 RESULTS Laboratory Sample Sample Cl Res Free (Field) Total Coliform E. Coli Plate Count ID Time Location mg/L P/A P/A CFU/ml 13E0065-01 13E0065-02 13E0065-03 13E0065-04 13E0065-05 11:15 11:00 10:52 9:44 9:29 4324 Old Hamner Rd 4335 Old Hamner Rd 4356 Old Hamner Rd Well 13 Well 14 1.10 1.10 1.20 A A A A A A A A A A <1 <1 <1 7 20 Stephen Kavousy Project Manager Post Office Box 329 San Bernardino, CA 92402 (909) 825-7693 Fax (909) 825-7696 ELAP Number 1088 Attachment No. 2 Drinking Water Notification to Consumers PROOF OF NOTIFICATION Name of Water System: Please explain what caused the problem if you have determined what it was and what steps you have taken to correct it. Consumers Notified __________ Yes __________ No If not, Explain: Date of Notification: On the date of notification set forth above, I served the above referenced document(s) on the consumers by: _____ Sending a copy through the U.S. Mail, first class, postage prepaid, addressed to each of the resident(s) at the place where the property is situated, pursuant to the California Civil Code. Attach copy of Notice. _____ Newspaper (if the problem has been corrected). Attach a copy of Notice. _____ Personally hand-delivering a copy to each of the consumers. Attach a copy of Notice. _____ Posted on a public bulletin board, that will be seen by each of the consumers (for small, non-community water systems with prior Department approval). Attach copy of Notice. I hereby declare the forgoing to be true and correct under penalty of perjury. Dated: ___________________ _____________________________________ Signature of Person Serving Notice **Notice: Complete this Proof of Notification and return it along with a copy of the notification to the Department within 10 days of receipt of giving public notice. Disclosure: Be advised that the California Health and Safety Code states that any person who knowingly makes a false statement on any report or document submitted for the purpose of compliance with the attached order may be liable for a civil penalty not to exceed five thousand dollars ($5,000) for each separate violation for each day that violation continues. In addition, the violators may be prosecuted in criminal court and upon conviction, be punished by fine of not more than twenty-five thousand dollars ($25,000) for each day of violation, or be imprisoned in county jail not to exceed one year or by both the fine and imprisonment.