Water Microbiology Laboratory Evaluation Form - Illinois Department Of Public Health

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WATER MICROBIOLOGY LABORATORY EVALUATION FORM
State of Illinois
Illinois Department of Public Health
Laboratory ___________________________________________________ Laboratory Number____________________
Certification
Officer(s) ____________________________________________________ Evaluation Date ______________________
Address:
Street ________________________________ City ______________________ State _____ ZIP Code ___________
Telephone________________________ Fax ______________________ E-mail ______________________________
Mailing Address (if different):
Street ________________________________ City ______________________ State _____ ZIP Code ___________
Laboratory Personnel
Experience/ time at
Position/Title
Name
Education Level / Degree
current position (years)
Supervisor
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
Analyst
1

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