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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.
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