DDW-2025-008474

WATER SYSTEM INFORMATION
Thank you for your business
Name of Water System:Brooklyn Tap
Operator:Scott Hansen
Water System:21004
Phone Number 4356333212
County:Sevier
Address:642 N Brooklyn Rd
City:Monroe
State:Utah
Zip Code:84754
Primary Email [e-mail]
Alternative Email
SAMPLE TYPE
Sample Type Bacteria
Lab Number (from sticker):1787
Description of Sampling Point:495 South Brooklyn Road, Elsinore
Distribution (DS001) or Source (WS00#) ID Ds001
Date Collected:06/09/2025
Time Collected:06:15
Is Sample Chlorinated?No
Reportable Routine
Routine: the results will be reported to the state.
SIGNATURE
Customer Name:Scott Hansen
Signature:
Central Utah Water Lab will submit all Routine results. It is ultimately the responsibility of the water
system to make sure it was inputted in to the state system.
TESTING STARTED
Date 06/09/2025
Time 15:45
PROCESS SAMPLES
Lab Number 1787
Sample Analyzed?Analyzed
Tested Date:06/10/2025
Submitted by Water Lab at 06/10/2025 22:02 UTC Page: 1
Captured at 06/10/2025 22:02 UTC gocanvas.com
Submission ID: 089AFDE7-ED65-4D33-A77E-D64D90042684
No.: 05695
Date: 06/10/2025Water System
Tested Time:16:02
Sample Type:Bacteria
Total Coliform (Per 100 mL):Absent
Total E. Coli (Per 100 mL):Absent
Satisfactory, your sample tested negative for total coliform and E. Coli
SIGNATURE (2)
Name:Eric Larsen
Signature:
Submitted by Water Lab at 06/10/2025 22:02 UTC Page: 2
Captured at 06/10/2025 22:02 UTC gocanvas.com
Submission ID: 089AFDE7-ED65-4D33-A77E-D64D90042684
No.: 05695
Date: 06/10/2025Water System