20120723CCH to Staff 21-49.pdf

570 S. YELLOW STONE AVE.
RECEIVED IDAHOFALLS, IDAHO 83402
cintry club hills utilhtieSfl2 JUL 23 PM 12 57 PHONE [phone]
July 19, 2012
UTIUTIES C)MMISSiO
Mr. Neil Price
Deputy Attorney General
Idaho Public Utilities Commission
472 W. Washington
Boise, Idaho 83702-5918
RE: Case No. CCH-W-12-1
Dear Mr. Price:
In response to your Second Production Request for the subject project, CCHU offers the following reply:
Request No. 21 - A Copy of the insurance bill is included with this report. CCHU pays its Liability
Insurance through Mike Groth's personal Homeowner's Policy.
Request No. 22- CCHU sends one bill per month to each customer which includes both water and
sewer. For the aged accounts it would be fair to say that half of the aged amount is charged to the
water, and half the aged amount Is charged to the sewer. Collection problems for the condominiums are
similar to the problems of the single family residents, and the aged receivable percentage has increased
over the past five years for both the single family and condo residents.
Request No. 23— Mike Groth is on call 24 hours a day, 7 days a week, 365 days a year to respond to
water system problems. However, in general, Mr. Groth averages approximately 3 hours per day
Monday-Friday in the administration of Country Club Hills Utilities Water System.
Request No. 24— No water service lines have ever been abandoned.
Request No. 25—Reconciliation is not provided with this report for the differences noted in the request.
We are in the process of reviewing the numbers and will send the reconciliation under a separate cover.
Request No.26 - No customer deposits are being held.
Request No. 27—Country Club Hills Utilities are presented Cash basis.
Request No. 28— a.) Office Space ($500/month), Warehouse Space ($200/month)
b.)No invoices are prepared
c.)No Contracts have been drawn up
d.)Unwritten Rental Agreement is with Pembroke Corporation a company owned by
Mike Groth.
e.) No arms lengths equivalents are available
Request No. 29 - $250/month vehicle lease for 11 months in 2011 for a total of $2,750. The remaining
$2,050 was for basic vehicle maintenance (fuel and oil changes) for which no receipts are available.
Request No. 30— $3,779.66 was spent to pay for heat and lights for the Administration office, and
$1,028.44 was spent to pay for telephone, for a total amount for heat, lights and telephone of $4,808.
Request No. 31 - An electronic version of an Excel Spreadsheet with customer billing information is
included herewith.
Request No. 32— Copies of Teton Microbiology's Lab reports on the drinking water quality are included
with this report. There are no test results showing that silt or sand is a problem, and if this is a problem,
CCHU has not been made aware.
Request No. 33 Copies of all the repair invoices are included with this report.
Request No. 34— Copies of the invoices supporting the installation of the VFD on Well No. 2 are
included with this report. The work was performed in the 0 quarter of 2004. Information is not
available for the reduction in power consumption, as power consumption information before and after
the VFD installation has never been kept.
Request No. 35—A new 25 hp pump was installed in 2006 by American Pump on Well No. 1 for
$11,749.26 and that pump failed. A new 30 hp pump was installed in 2011 by Denning Well for $7,755.
A 30 hp pump was installed because it was the only pump available at the time, and there was no time
to order a 25 hp pump. The American Pump invoice was larger than the Denning invoice because before
American Pump installed the 25 hp, they spent several days fishing out the old pump because the drop
pipe broke. The cause for the pump failure was unknown and the warranty period had ended. These
are the types of random incidents that occur to small water systems that one cannot plan for.
Request No. 36—The 30 hp pump Denning Well Drilling installed in February 2005, failed in August of
2008, at which time a slightly used 30 pump was installed. Similar services were performed on both
service calls. There is no explanation as to why the pump failed after only three years, but not replacing
it is not an option, particularly when it fails in the summer.
Request No. 37 - CCHU does not ask for quotes and bids because typically there is not time to go
through that process when a pump fails. When a pump fails, it needs immediate attention, and CCHU
calls contractors who are familiar with the project and can act at a moment's notice.
Request No. 38—There are no written complaints on file.
Request No. 39— CCHU asks for and receives no deposits from its customers.
Request No. 40- Copies of the typical monthly bills are enclosed with this report.
Request No. 41— CCHU typically starts reading meters in April of each year and the meter reading
operation stops in September or October. When the meters are read for the first time each year in
April, 30,000 gallons per month are subtracted from the meter reading prior to calculating the
commodity charge.
Request No. 42— CCHU sends all customers a monthly billing statement. All of the single family
residential customers are billed under a metered rate and the commodity charges are calculated based
on the latest approved tariff. Sample bills are enclosed with this report.
Request No. 43— CCHU has a pre-printed form outlining what to do in case of a medical emergency. A
copy of the form is enclosed with this report.
Request No. 44—A copy of the Summary of Rules and Regulations are enclosed with this report. The
summary is mailed to new customers.
Request No. 45— Rate schedule explanations have historically never been sent.
Request No. 46—The Notice to Terminate Notice is enclosed with this report.
Request No. 47— CCHU handles past due bills by contacting the customer by a telephone call initially,
and then followed up by sending out the Notice to Terminate.
Request No. 48—The price of fuel has made it necessary to increase the reconnection fee to $50.
Request No. 49— CCHU collects a hook-up fee to customers making a new connection to the system.
This fee pays for the meter and manpower necessary to hook-up the meter. It also falls in line with the
other connection fees of the area. It should be noted however, that there have been no new hook-ups
in the last several years.
Thank you for the opportunity to provide the above information.
Sincerely,
Country club Hills Utilities We -
Mike Groth, President
Enclosure
Item 21
Documentation
Bill Account Activity Bill Account # 5581107721
DATE POLICY # DESCRIPTION AMOUNT 06/04/10 Payment Received - Thank You -$1,036.68 12/07/10 55 ABA 376878 Renewal Premium $2,285.00 12/13/10 Service Fee - Please Pay Only If You $5.00
Choose An Installment Payment Option
DESCRIPTION OF VEHICLE AND OR PROPERTY INFORMATION
935 1ST STREET IDAHO FALLS ID 83401
BILUNG INFORMATION
Insufficient Funds Fee - A $15.00 charge will be assessed for any payment returned by your bank for
insufficient funds.
Late Fee- a late payment fee is assessed when the minimum due is not received by the due date shown
on your Insurance Bill, except where prohibited by law.
SERVICE FEE INFORMATION
For installment plans, a service fee is included in each payment except where legally prohibited.
CONTACT US
To speak to a representative, please call the Customer Service number.
Save Time and a Stamp! Pay Your Bill Online - Visit http://aarp.thehartford.com/mypolicy
Check Processing - When you provide a check as payment, you authorize us to either use Information from your
check to make a one-time electronic fund transfer from your account or to process the payment as a check
transaction.
This CONTINUATION Page, With the Forms And Endorsements
Listed Below CONTINUES Your HOMEOWNERS POLICY.
tuy
INSURER: HARTFORD INSURANCE COMPANY OF THE MIDWEST HARTFORD 200 HOPMEADOW STREET, SIMSBURY, CT 06089
DECLARATIONS
POLICY NO. 55 RBA376878

Named Insured and GROTH,MICHAEL P & MARY JILL
RESIDENCE PREMISES 935 1ST STREET
IDAHO FALLS ID 83401
Policy Period 12:01 A.M. Standard Time
at the Residence Premises 0. FROM 01-20-11 TO 01-20-12 TERM: 1 YEAR
Producer Name: CODE: 553780 MEE CUSTOMER SERVICE: 1-800-423-0567 CLAIM SERVICE: 1-877-805-9918
TOTAL POLICY PREMIUM: $ 2,285.00
COVERAGE IS PROVIDED WHERE A LIMIT OF LIABILITY IS SHOWN FOR THE COVERAGE.
COVERAGES LIMIT OF LIABILITY
SECTION I
A.DWELLING $ 707,000
B.OTHER -STRUCTURES $ 70,700
C PERSONAL PROPERTY $ 494,900
D.LOSS OF USE $ 141,400
SECTION II
E.PERSONAL LIABILITY: EACH OCCURRENCE $ 300,000
F.MEDICAL PAYMENTS TO OTHERS: EACH PERSON $ 1,000
DEDUCTIBLE - SECTION I WE COVER ONLY THAT PART OF A LOSS OVER $ 250
MORTGAGEE: LOAN NO. 0237648985
SUNTRUST MORTGAGE INC.
ISAOA
P.O. BOX 57028
IRVINE CA 92619
COUNTERSIGNED BY 944101R. QOh AUTHORIZED AGENT
----CONTINUED ON PAGE 2-
qM H-525 (9/03) 1588
DECLARATIONS (CONTINUED) POLICY NO. 55 RBA376878
NAMED INSURED: GROTH,MICHAEL P & MARY JILL
RATING INFORMATION:
1 FAMILY FRAME DWELLING BUILT IN 1936
STATE 11 TERR. 00025 PROTECTION CLASS 3
FIRE PROTECTION PROVIDER IDAHO FALLS
WITHIN 1000 FEET OF A FIRE HYDRANT AND WITHIN 3 MILES OF A FIRE STATION
INSIDE CITY LIMITS PREMIUM GROUP 1.00
FORMS AND ENDORSEMENTS NOW MADE PART OF THIS POLICY:
(ENTRIES ON ENDORSEMENTS MAY BE LEFT BLANK IF SHOWN ELSEWHERE IN THE POLICY) HO 00 03 10 00 SPECIAL FORM BASIC PREMIUM $ 1,838.00 HW 05 44 04 05 PROTECTORPLUS ZERO DEDUCTIBLE PREMIUM NIL HW 01 59 12 07 SPECIAL PROVISIONS - IDAHO PREMIUM NIL HW 01 04 06 03 HOMEOWNERS POLICY POLLUTION EXCLUSION PREMIUM NIL HW 01 03 06 03 AMENDATORY ENDORSEMENT PREMIUM NIL HO 04 96 10 00 NO SECT II COy-HOME DAY CARE BUSINESS PREMIUM NIL HO 04 16 10 00 PREMISES ALARM OR FIRE PROT. SYSTEM CREDIT $ 184.00 10 PERCENT CREDIT
HO 04 61 10 00 SCHED PENS PROP-ACT CASH VALUE PREMIUM $ 111.00 CL 1 JEWELRY AMT $ 18,479 PRM $ 111.00 HW 01 01 06 03 LIFETIME CONTINUATION AGREEMENT PREMIUM NIL HO 04 90 10 00 PERS PROP REPLACEMENT COST LOSS STLMNT PREMIUM $ 184.00 HO 04 27 04 02 LIMITED FUNGI, ROT OR BACTERIA COV PREMIUM NIL
$5,000 PROPERTY DAMAGE $50,000 LIABILITY HO 04 92 10 00 SPECIFIC STRUCT AWAY FROM RES PREMISE PREMIUM $ 320.00
Es
COVERAGE E OR F INCREASE PREMIUM $ 8.00 ADDITIONAL INSURED LOCATIONS (SECTION II ONLY) PREMIUM $ 8.00
TOTAL PREMIUM $ 2,285.00
AUTOMATED LINE 1 -800-423-0567 BILLING ID 81107721
- PLEASE NOTE -
A LOSS FREE CREDIT DOES NOT APPLY TO YOUR POLICY
ADDITIONAL INSURED LOCATIONS (SECTION II ONLY)
1780 2ND AVE TERRITORY HAlLEY BAYNE B ID 83333 NO OF FAMILIES 1
15% AUTOMOBILE CREDIT APPLIES- INCLUDED IN BASIC PREMIUM
100% OF THE REPLC COST FOR COVERAGE A
05% RENEWAL CREDIT APPLIES - INCLUDED IN BASIC PREMIUM
SECTION I COVERAGES HAVE BEEN CHANGED
THE RATING INFORMATION HAS BEEN CHANGED
THE FOLLOWING ITEMS ARE ENCLOSED FOR YOUR REVIEW.
DRH-5-2 FLOOD INSURANCE NOTICE
DRA-928-1 OPT-OUT NOTICE
THE LIMIT OF LIABILITY FOR SECTION I COVERAGES MAY BE ADJUSTED
ANNUALLY BASED ON THE INFLATION RATE IN YOUR AREA.
FORM H-525 (Ed. 9/03) 11-16-10 12-07-10 12-07-10 1589
Item 32
Documentation
258 N. Water Ave Sue #2 - Idaho Falls, ID 83402

Adak phone[phone]fax[phone]
emoil: tetonmicrolabnuziL corn www.tetonndcro.com
INVOICE
Invoice Date: Pistil)

Bill To: Country Club Hills Work Order No. 1101083
570 S Yellowstone Ave
Idaho Falls, ID 83402 P0 Number.
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECT: Total Coliform/E. Coil

Coil. Date Sampling Point Sample Description List Price
01/11/11 11278 Augusta Total ColifornilE.coli P/A - $20.00
Please Pay This Amount $20.00
if..., ....,., i.... .,1...,.,_1.. .,.,,. .-.I.-.,., ,.......A il.;..
t
LDIIIlU CLU1 V.
Tetow' cout*y41 . h!' util(tlii Microbiology Lab
:blic Water System Phone: --- -
Private System
Fax S2 cO?
reserved WithSodium ThiosuJtteI
I _____________
TETON MICROBIOLOGY LABORATORY ID: 1D00969
258 N Water Avenue Suite 2 Idaho Falls, IDAHO 83402
Qjflce: 208-529-0077— Fax: [phone] tetonmicro.com
Client Sample Lab Sample Sample
Number Number Type
Cod
Sampling Location Thne
Collected
Chlorine
residual
rrxvi
Original Sample
Date
Total Coliforms Eseherichia Coli
Method Code
Ijseot(A)h.ent
I f #100"11
Method

Method Code I
I(P)reaeat(A)bsent
110106301 lIZ? ? A06IIST4'e 9223B-PA A 9223B-PA A
92311-PA 9223B-PA
I 9223B-PA 9223B-PA
9223B-PA 9223B-PA
923B-PA 9223B-PA
S-Routme sample C.ccxntnictionispeciai W-ntreatetisource P-Repeat Sample U-Upstream Repeat D-Downtream Repeat X-Other Repeat
E-Enfercement (Chain of Custody Requi red) (At Original Tap)
Chain-of-Custody Information
MhLe Date:
/
Time Received
A Rehiquishedby Date: Time: Received by
Rellequishedby Date: Tine: Received by Reliquishedby Date: Time: Received by
DATE/TIME RECEIVED: ANALYSTL,j REMARKS:
DATE/TIME ANALYZE: I I 31 SUPERVISOR:
DATE/TIME READ: ii LAB H) #: 11)00969
Send Reside To:
DEQ r:. DEQPUI
0 Dist 7 Other
Dtst6
258 N. Water Ave Suite #2- Idaho Falls, ID 83402
phone[phone]fax[phone]
email: tetonmicrohth(ãgmaiL corn www.teionmicro.com
INVOICE
Invoice Date: February 24, 2011
Bill To: Country Club Hills Work Order No. 1102176
570 S Yellowstone Ave

Idaho Falls, ID 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECT: Total Coliform/E. Coli
CoIL Date Sampling Point Sample Description List Price
02/24/11 12005 Sunrise Cr. Total Coliform/E.coli P/A $20.00
Please Pay This Amount $20.00
!erved With Sodium ThiosulfaW._J
TETON MICROBIOLOGY LABORATORY ID: 11)00969
258 N Water A venue 'Suite 2 Idaho Falls, IDAHO 83402
Office: 208-529-0077 - Fax: [phone] telonmicro.com
Client Sample Lab Sample Chlorine OrióIe
Number Number ,!tb0n

residual ::ode 11t MeCo4e
110217601 922~XPA A 92238-PA A
9223B-PA 9223B-PA
9223B-PA 9223B-PA
9223B-PA 92238-PA
922B-PA 92238-PA
S-Route San* C.constiospecia W-UnUeatetSowce) P-gepeat sample U-upstream Repeat D-.Downtream Repeat X.Other Repeat
E-Enrcemem (Cheat of Custody Reqused) (At Original Tap)
Chain-of-Custody Information
Reliiqws Date: Time. : Recetvedby R eitquishedby Date Tim: Received by
Reboquishedhy Date: Time: Received by L) Renquishedby Date Tim: Received by
DATE/TIME RECEIVED:
DATE/TIME ANALYZE: J /
DATE/TIME READ:

ANALYST:,h -
REMARKS.
SUPERVISOR:
LAB ID #: 1D00969
send Restdts To
El DEQ 0 DEQPH
Dist 7 Other
17 Dist 6
258 N. Water Ave Suite #2-Idaho Falls, 1083402
• phone[phone]fax[phone]
email: tetonmkrolab®gmajLconz www.teWnmicro.com
INVOICE
Invoice Date; March 24, 2011
Bill To: Country Club Hills Work Order No. 1103179
570 S Yellowstone Ave
Idaho Falls, II) 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECT: Total Coliform/E. Coli -
Coil. Date SanllngFointnçWeI)exrition List Price
03/24/11 2020 E. 113 S. Total oliform/E.co1i P/A $20.00
Please Pay This Amount $20.00
Water System Namc:COtJ TRY. CLUB fitusUTIL ITIES PWS U)
Collector Collect Date Cot,.
DAle /V€4iLS 3-/J4-.j1 OJ
Person Transportam Sample To tab:
Condition of Transport: CUSSICI Carrier Mail other
portRsuitsTo: country club hills utilities
570 SO. YELLOWSTONE AVE..
IDAHO FALLS, IDAHO 83492
Phone Number 1 Fax Number
- ~-O'7o1
Billing Address:
country club hills utilities
570 SO. YELLOWSTONE AVE..
IDAHO FALLS, IDAHO 83402
uic Water System
Private System
Preserved With Sodium ThiosuffateI]
TETON MICROBIOLOGY LABORATORY ID: 1D00969
258 N Water Avenue $juite 2 Idaho Falls, IDAHO 83402
Office: 208-529-0077 -Fax: [phone] let c'nmicro.com
C
Client Sample
Number
Lab Sample
Number
Sample
1'pe
j.' ..I .uue
Sampling Location Time
Collected
Chlorine
residual
FFIVI
Original Sample
Date
1taI Coliforms Escherichia Coti
Method Code ODP.a
P)raaenttAJbscst
1 #iOOmt MethodCode
P)resent(A)bsent
I NlOOml
110317901 5 92238-PA A_9223B-PA
92238-PA 9223B-PA
9228-PA 92238-PA
92238-PA
922B-PA 1
92238-PA
92238-PA
[mptr Cconstruction/specleI W-Untreated(Sourcct PRepeat Sample U.Lipstream Repeat D-Downstream Repeat X-Other Repen
[nt tthao it I tistody Required) (At Original Tap)
Chain-of-Custody Information
R he Date:
1-2 14- 11t
Time Receive by Relisqwshed by Date Tane Received by
Reletquished by Date: Time Received by Relmquished by Date 1 tmr Riceived by
DATE/TIME. Kl(IIVEI): 3))ij
1)ATET1IME ANAl V/I
DAli! I INIL RIIAD
ANALYS RIMARKS
SUPERVISOR
LAB It) #: 1D00969
Send Results To
DEQ DIQI'lt!
Dist 7 ()thi
Out 6
258 N. Water Ave Suite #2 - Idaho Falls, ID 83402
S pbone(208)-529-00 77fax[phone]
email: [e-mail] www.tetonmicro.com
INVOICE
Invoice Date: April II, 2011
Bill To: country Club Hills Work Order No. 1104090
570 S Yellowstone Ave

Idaho Falls, ID 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECP Total ColiforuifE. coli
Coil. Date Sampling Point Sample Description List Price
04/11/11 11585 Pinehurst Total Coliform/E.coli P/A $20.00
ri
Please Pay This Amount $20.00
Water System Name. COUNTRY CLUB 14fl.L5 UTIUTI5
Cotector
1)
(tater Date County:
Person Transporting Sample To Lab5
Condition of Transport: Ctxiled ar Mal Other
Repqrt Resu ltsjo: country club hills utlitlo
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO $3402
Phone Number. a' \urnber
Billing Address:
Teton country club hills utilities ocro biolo gy • 570 SO. YELLOWSTONE AVE.
- IDAHO FALLS, IDAHO 83402
ublic Water System 2. '5 oø P w &
Private System
wed With Sodium Thiosulfate Fax:
TETOT MICROBIOLOGY LABORATORY ID: 1000969
258 N Water Avenue Suite 2 Idaho Falls, IDAHO 83402
Offlce:208-529-0077 -Fax [phone] tetonmicro.com
C
Client
Sample
Number
Lab
Sample
Number
Sample
Type
Code
Sampling
Location
Time
Collected
L' IC
Chlorine
residual
PPM
Original
Sample
Date
Total Coliforms Escherichia Coli
Method Code (P)reaent(A)b,ent
$1ml Method Code (P)resent(A)bseat
#lmI
f*109o01 5 &4$ 922313-PA ,47 9223B-PA /9 922313-PA 9223B-PA
92238-PA 922313-PA
-
9223B-PA
92238-PA
9223B-PA
9223B-PA
[ S.goutme sample C-coaestructtrmispecrai W(ntrad(S4,urs) P Repeat Sample U Upstream Repeat D-Downstreazi Repeat X-Other Repeat
E-Enforcemen(ChaiofcustodyReqaed) (At Original Tap)
Chain-of-Custody Information
R,kMwJWd by Date Ti$e Recessed Relinquished by Date: Tine: Recessed by
1QL L —.' c t4Q L
Rchoqábed by Date linc Recessed by Relequished by Date: Tine: Received by
DATE/TIME RECEIVED:
DATE/TIME ANALYZE:
Alyt

ANALYST,/ . REMARKS:
SUPERV9 >
DATE/TIME READ: 'i LAB ID #: 1D00969
Send Results To.
DEQ DEQPIH
Dist 7 Other
Dist
258 N. Water Ave Suite #2-Idaho Falls, ID 83402
phone[phone]fax[phone]
email: tetonmicrolab(ãjgmaiL corn www.tetonrnicro.com
INVOICE
Invoice Date: May 16, 2011
Bill To: Country Club Hills Work Order No. 1105114
570 S Yellowstone Ave
Idaho Falls, ID 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJEC1 Total ColiformlE. coli
Coil. Date Sampling Point Sample Description List Price
05/16/11 2155 Olympic Total Coliform/E.coli P/A $20.00
Please Pay This Amount $20.00
Water System Name CQUN11Y CLUE KIIiS UTIUTIES PWSIDno,
Cottector
I
Cocct Date: Coteity.
1100O3
DII j'V4q-/'S
Person Transportmg Samp'e To Lab
Condition of Transport: Cooled Carrier Mail Oft,
Report Results To: country club hills utilities
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
Phone Number FaxNt,nber:
S2 - o71
Billing Address:
country club hills uthitie
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
i"Public Water System
ri Private System
ved With Sodium Thiosulfate
TETON MICROBIOLOGY LABORATORY ID: 11)00969
258 N Water Avenue Suite 2 Idaho Falls, IDAHO 83402
Office: 208-529-0077 - Fax [phone] tetonmicro.com
5°
£2d1_6701
Client
Sample
Number
Lab
Sample
Number
Sample
Trpe
Code
Sampling
Location
Time
Collected
Chlorine
residual
PPM
Original
Sample
Date
Total Coliforms Escherichia Coil
Method Code

i(P)resent (A)baent
#1001111
Method Code
(P)re,eat (A)bsent
0100tol
low 922313-PA A 9223B-PA A
110511401 /3jpfj) 922313-PA 922313-PA
9223B-PA - 922313-PA
9223B-PA 922313-PA
922313-PA 922313-PA
S-Routec Samp'e C.corstructionspecii W-untreaterource> P-Repeat Sample U-upstream Repeat D-townstream Repeat XOther Repeat
E-Enforcement (Chan of Custody Required) (At Original Tap)
Chain-of-Custody Information
Re Date: Tine,
1:07
Received Relinquished by date Tine Received by
Relitquishedby Date: Tine Received by Rebequiilatdby Date Tine Received by
DATE/TIME RECEIVED: . ANALYST: ) REMARKS: Send Results To
DATE/TIME ANALYZE; SUPERViSOR 3 DEQ DEQPIII
5 i . I C) Di 7 Other
DATE/TIME READ: 51 li t 0 LAB ID N: 11)00969 Dist 6
258 N. Water Ave Suite #2-Idaho Falls, ID 83402
I phone[phone]fax[phone]
email: tetonmicrolab®grnail.com www.tetonmicro.com
INVOICE
Bill To: Country Club Hills
570 S Yellowstone Ave
Idaho Falls, ID 83402
Invoice Date: June 21, 2011
Work Order No. 1106214
P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 13% PER MONTH
PROJECT: Total Coliform/E. coil
Coil Date Sampling Point Sample Description - List Price
06/21/11 11350 S. Bellerive Total ColiformlE.colj P/A $20.00
Please Pay This Amount $20.00
St
Water System Name: COUNTRY CUJS HILLS UTIUTIE5 PWS ID no 710OO
Collector
9A1c2 AJerit1
Collect Date: Cotaiy
/A)
Person Transporting Sample To Lab-
Condition of Transport: Fj cooled ri Carrier Mail Other
Report Results To: club hills utilities
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
Phone Number Fax Nianber
~2 oc)
OPublic Water System
Private System
ed With Sodium Thiosulfate
TETON MICROBIOLOGY LABORATORY 10: 11)00969
258 N Water Avenue Su*e 2 Idaho Falls, IDAHO 83402
Ojflce: 208-529-0077 * Fsx, 208-522-3797 tetonmicro.com
I Billing Address:
country dub hills utilities
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
Phone: 5zc -
Fax:
Client
Sample
Number
Lab Sample
Sample Type
Number code
Sampling
Location
Time Chlorine
Collected residual
PPM
Original
Sample
Date
Total CGlifbrnis Escherichia Coil
Method Code
(P)resent (A)lsaent
#ll Method Code (P)resent (A)bsent
110621401 5 /c U 922313-PA 9223B-PA /4
922313-PA : 922313-PA
922313-PA 922313-PA
9223B-PA 922313-PA
922313-PA 922313-PA
S-iotane Sample C-cnetniction'speci W.UstreatetSource) P-Repeat Sample U-upstream Repeat D-ownstream Rlpeat X-Other Repeat
L E-En*rcement (Cheat of Custody Requred) (At Original Tap)
Chain-of-Custody Information
Timm: .J.45 Re dby Relinquished by Date Tine Received by
Relisqsinhed by Date tane. Received by Relisquished by
-
Dst Tine: Received by
a
DATEPFIME RECEIVED:
DATE/TIME ANALYZE:
DATE/TIME READ:
Xlfr'5 A!ALYST:
su4/(,7 - -
LAB ID #: 1D00969
REMARKS: Send Results To:
050 DEQPII-1
Diet 7 Other
Oat b
258 N. Water Ave Suite #2-Idaho Falls, ID 83402
phone[phone]fax[phone]
email: tetonmicrolab®gmaiL corn www.tetonrnicro.com
INVOICE
Invoice Date: July 27, 2011
Bill To: Country Club Hills Work Order No. 1107200
570 S Yellowstone Ave

Idaho Falls, ID 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECT' Total Coliform/E. coli
Coil. Date Sampling Point Sample Description List Price
07/27/11 11278 Augusta Dr. Total Coliform/E.coIi P/A $20.00
Please Pay This Amount $20.00
Billing Address:
lublic Water System
! Private System J
-,vpd With Sodium Thiosulfate
country club hills utilities
510 $0. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
Phone: f 2
Fax: çc 070
TETON MICROBIOLOGY LABORATORY ID: 11)00969
258 N Wafer Avenue Suite 2 Idaho Falls, IDAHO 83402
Office: 208-529-00774 Fax. [phone] telonmicro.com
AW
Water systern4QWRY CLUB HILLS UTILITIES Pwsl7
Cc&cter Cflect per. C
J&'R, -41:e4al IS 7Z 7M QJ Aj
Person Transporting Sample To Lab: S 4rY1 a...
Condition of Transport: CociedCarran Mai Other
Report Results To: country club hills utMtl
570 $0. YELLOWSTONE AV..
IDAHO FALLS, IDAHO &Mg
Phone N'.inber: Fax Na,aber
S2..9O?o7
Client Lab
Sample Sample
Numk
Sample
Type
..ie
Sampling
Location
Time
Collected
Chlorine
residual
PPM
Original
Sample
Date
Total Coliforms Escherichia Coil
MetbodC*de
iiat(AeM
#1l MetbodCode
(P)reaeat(A)bseat
9223B-PA A 9223B-PA
9223B-PA 9223B-PA
9223B-PA 9223B-PA
9223B-Pi 9223B-PA
9223B-PA 9223B-PA

S-s.osteie Sample C uontspeelal W.untreaseSourqe) P-Repeat san U.upetream Repeat D.Downatzeam Repeat XOther Repeat

L Ecmt(C Custody Requn<I) (At Origi. tal Tap)
Chain-of-Custody Information
Date Twnei I
Rea Rley.unhed' Date Tine Recewedby
Retiquihedby Date Tine Received by Rcbrauishedby . Date. Tine, Recewcdy
DATEIIIMERECEIVED: O9St
DATEJT1MEANALVZE
DATEITTNE READ:
ANALYST(),, 3LREMARKS:
SUPERVISOR: U L)
LAB ID #: 1D00969
Send Results To
DEQ DEQPIH
Det7 Oder
Dist 6
258 N. Water Ave Suite #2- Idaho Falls, ID 83402
• phone[phone]fax[phone]
• email: tetornnicroiabgmaiL corn www.tetonmicro.com
INVOICE
Invoice Date: August 24, 2011
Bill To: Country Club Hills Work Order No. 1108238
570 S Yellowstone Ave
Idaho Falls, ID 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJEC'11 Total Coilform/E. coil
Coil. Date Sampling Point Sample Description List Price
08/24/11 12005 Stmrise Total Coliform/E.coli P/A $20.00
Please Pay This Amount $20.00
Water System Name: J CLUB WU.S UTILITIES 107100023
Coector: Collect Date. County
DM- ies
Person Transporting Sample To Lab: 5 R iY\
Condition of Transport: Cooieti Carrqr Mall Other
pert Results To:
Country Club Hills
570 S Yellowstone Ave
Idaho Falls, ID 83402
Phone Number: Fax Number:
[phone] (208) 529-070
S
Billing Address:
Country Club Hills
I 570 S Yellowstone Ave
Idaho Falls, ID 83402
Public Water System Phone:
Private System
ved With Sodium Thiosulfate - Fax:
* TETON MICROBIOL V LABORATORY ID: 1D00969
258 N Water Avenue 2 Idaho Falls, IDAHO 83402
Office; 208-529-0077-- x: 208-522-3797 tetonmicro.com
Client Lab Sample Sampling Time Chlorine Original Total CMiforms Escherichia Coli
Sample Sample Type Location Collected residual Sample (P)ent(A)bent (p)resent(A)baent
Number Nujbr Code PPM Date Method MethodCode
9223B-P2 A 9223B-PA A -
9223B-PA 9223B-PA
9223B-PA 92238-PA _______ -.-.--.--.----- - --,
9223B-PA 9223B-PA
92238-PA 9223B-PA
S-Routine Sample C-coosrnction/specialW-untreated(Sou4e) P-Repeat sample U-Upstream Repeat D-Downstream R'peat X-Other Repeat
E-FAifmemnt(c.heinofCuswdyRequ*ed) (At Original Tap)
Chain-of-Custody Information
Re Datei Time:4 .fRele1wshed by Date Thx Received by
Renquished by Date: Tune: Received by Rebnquahed by Date Time, Received by
DATE/TIME RECElVID:
DATE/TIME ANALYZE: jq
/j
DATE/TIME READ: g
ANALYST:
t SUPERVISOR:
tf 3 LAB II) #: 11)00969
Send Restiks To
DIiQ DEQPIU
Dist 7 Other
Dist 6
258 N. Water Ave Suite #2-Idaho Falls, ID 83402
pbone(208)-529-00 77fax[phone]
email: tetonmicroIabgmaiL corn www.tetonmicro.com
INVOICE
Invoice Date: September 13, 2011
Bill To: Country Club Hills Work Order No. 1109114
570 S Yellowstone Ave
Idaho Falls, ID 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJEC1 Total ColiformlE. coil
Coil Dale Sampling Point Sample Description List fWag
09/13/11 2020 E. 113 Total Colilbrm/E.coli P/A
Please Pay This Amount $20.00
Water SYsnenNam(Jp $ WUPS UT1UT1S ID ?10O03
Coflector. Collect Date
b41- j,rhc c1311
Peraon Trancpcnitg Sample To Lab:
Condition of Transport: Cooled Carrier Mail Other
RDort Results To: country club hills utte
so;YESeN€Avt
IWHO FALLS, IDAHO 83402
Phone Number: Fax Nwnber
01 0 7
Blihina Address:
country club hits utllitie
J[7J$JflW7] 57080. VELLNSTONE AVL
IDAHO FALLS IDNIO 83402
?tiblic Water System Phone: — *
Private System
Fax: C
TETON MICROBIOLOGY LABORATORY ID: 11)00969
258 N Water Avenue Suite 2 Idaho Fails, IDAHO 83402
Office: 208-529-0077 - Fax [phone] tetonmicro.co,n
Client
Sample
Numb
Lab
Sample
[Sample
Type
Sampling
Locatioá
Time
Collected
Chlorine
residual
PPM PPM
Original
Sample
Date
ibtal Coliforms Escherichia Coil
Method Code
(a,nt(A)hoeat Method Code (P)reseot(A)baeat
g ,~ tvl 92238-PA A 92238-PA A
92238-PA 9223B-PA
92238-PA 9223B-PA
922313-PA 92238-PA
922313-PA 92238-PA
S-aoioic sample C-Ctio&peci W-UteSo) P-Repeat sample U-otream Repeat D.Downstream Repeat X-Othe Repeat
E-Enfcecement (Chin of Custocy Required) (At Original Tap)
tnain-of-Cus tody intormanon
Retishedby Dam 9/f;/// 4LIg 1Time: 1Rece t Rehreus hed by D te: Toe: Received by
Relñuisbedby Date: Tine: Received by l&ehoqwshedby Dkte Tine: Recewedby
DATE/TIME RECEIVED: 9/4r YST:
DATE/TIME ANALYZE: /4 / S ERVIS
DATE/TIME READ M/k. J, LAB H) # W%91.
REMARKS: Send Rezuks To:
DQ DEQPIH
Dist 7Oder
Dar
258 N. Water Ave Suite #2 - Idaho Falls, Li) 83402
0 pbone(208)-529-00 77fax[phone]
email: tetonmicrolal,®gmaiL corn www.tetonmicro.com
INVOICE
Invoice Date: October 18, 2011
Bill To: Country Club Hills Work Order No. 1110167
570 S Yellowstone Ave
Idaho Falls, ED 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECTS Total ColiforuilE. coli
Coll. Date Sampling PointSample Description List Price
10/18/11 11585 Pinehurst Total ColiformlE.coli P/A $20.00
Please Pay This Amount $20.00
If payment has already been sent, please disregard this notification.
watersyatemNan COUNTRY CLUB I4fliS UTILITIES Pws ,D n.1OoO3
Co&ct:
ç
Collect Date: County
Person Transporting SampleToLeb ,4? Pr) e
Condition of Transport: c Mail M other
Report Results To: CoUntry dub hills utZlltle
$70 SO. YELLOWSTONE AVE
l4O PAILS. KWIO $34
Phone Number. 1P.Num1w, 5o7o7
Bi11102 Address:
cOUfltJy club hft uUUtIós
IiTThIIPWPIE'I $70 SO. YEU.OWSTOP AVE.
O FAIL% t wo t02
't4lic Water System Phone: 0
Private System
Preserved With Sodium Thiosulfate j Fax. 529 —07
TE'ION MICROBIOI4)GY LABORATORY ID: 11)00969
258 N Water Avenue quite 2 Idaho Fails, fDAHO 83402
Q/flce: 208-529-0077 —Fax. [phone] letonmicro.com
Client
Sample
Numb
Lab
Sample
Sample
Type
Sampliig
Location
Time
Collected
Chlorinel
residual
PPM
Original
Sample
Date
Total¼o11*wnis Escherlchla Cell
Method Code (?).eeaet(A)hoent Method Code
(P)neseet(A)baent
9223BPAL A 922313-PA A
922313-PA 922313-PA
922313-PA 922313-PA
9223B-PA 922313-PA
9223B-PA 9223B-PA
S-ROMWSample C-conemrtle&Special W.unroascui4 P.Repeat Sample U-uretream Repeat D-Downatrem Repeat X-other Repeat
EEnforcemet (Clain of Custody Reqáed) (At Original Tap)
Main-of-Custody Information
Peceived bi tA.€ Releiqulehedby Da Tone: Received by JTIB6
Re&.quithed by Date: Tine: Received by Roinquished by Date: line: Received by
ANALYST:1)% £L.s9tLtZ-' REMARKS:
- SUPERVISOR: U DEQ DEQPIH

-,., ........................................................Dist 7Other
LAB ID 1000969
-(Q~)
DATE/TIME RECEIVED: jL S7
DATE/TIME ANALYZE: lip
DATE/TIME READ: jO/,)jL
Vf-L e.jnt .&s
258 N. Water Ave Suite #2-Idaho Falls, ID 83402
phone[phone]fax[phone]
email: tetonmicrolab(ãjgmaiL corn www.tetonmicro.com
INVOICE
Bill To: Country Club Hills
570 S Yellowstone Ave
Idaho Falls, ID 83402
Invoice Date: November 28, 2011
Work Order No. 1111172
P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECT Total ColiformfE. coli
Coil. Date Sampling Point Sample Description List Price
11/28/11 2155 Olympic Total Coliform/E.coli P/A $20.00
Please Pay This Amount $20.00
If payment has already been sent, please disregard this notification.
Billing Address:
W1ubIic Water System
Private System
ved With Sodium Thiosulfate
TETON MICROBIOL
258 N Wafer Avenue
Office: 208-529-077 -
country club hills uthltleø
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
Phone: 62.1 'c
Fax: 51, 9 (0 5)
LABORATORY lID: 11)00969
2 Idaho Fails, IDAHO 83402
208-522-3797 tetonmicro. corn
Wter System Name : COUNTRY CLUB WU$ UTIUTLS PWS1D1(V
Coflector:
1l-e &-cn4-('c
CoLlect Date:
1141-li
Cotmty:
Pervtoportiu Sanc To Lab m. e
Condition of Transport: Corner Mai Other
çrt Results To: country dub tmsututti
570 80. YELLOWSTONE AVE.
IDJ4O FALLS WHO $3402
PhNtanber IFXNtInhot
1Z cF 52 ¶
Client
Sample
Numr
Lab
Sample
I'—'---
Sample
Type
Sampling
Loc atiofl
Time
Collected
Chlorine
residual
PPM
Original
Sample
Date
Total ddilbrms Eseherichia Co1i
Method Code (P)res.at(A)beent Method Cod, (Preaeat(A)beent
922313-PA 922313-PA 1 A
922313-PA 922313-PA
922313-PA 9223B-PA
9223B-PA 9223B-PA
9223B-PA 9223B-PA
S.Rotie Simple C.cosuiictnt'speciai W-UntcateSorwcc) P-Repeat Sample U.upaueam Repeat D.Dowmtream Repeat XOtimr Repeat
J (At Original Tap)
Chain-of-Custody Information
Date: Tine:fRweiv Re iq ed by Date: tane: Received by
Reiirquisbedby Date: Tent: Received by fte&Xiepshedby Ete: Tine: Receiodby
DATEP1ME RECEIVED: ANALYST R.EMARK: Send Results To:
DATE/TIME ANALYZE:1 UPERVIS
- - -
DQ DEQPLFI
Dist 7 Odr
DATE/TIME READ: LAB II) 4: 1D00969
Dist 6
Ii
258 N. Water Ave Suite #2- Idaho Falls, ID 83402
• pbone(208)-529-0077fax[phone]
email: tetonmicrolabgmaiL corn www.tetonmicro.com
INVOICE
Invoice Date: December 15, 2011
Bill To: Country Club Hills Work Order No. 1112148
570 S Yellowstone Ave
Idaho Falls, ID 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECT. Total Coliform/E. coli
Coil. Date Sampling Point Sample Description List Price
12/15/11 11278 Augusta Dr. Total ColiformIE.coli P/A $20.00
Please Pay This Amount $20.00
If pant has already been sent, please disregard this notification.
Water System NameCOIJN7y CLUB HJU3 UTIUT1E PWSI X
Coctor: Collect Data County:
110 e, er\ts
Persce Transport" Sample To Lab, yfl (
Condition of Transport: Canr M Mall in Othat
Report Results To: country club hills uthItis
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402 1
Phom Number PaNtanber:
529bo?ol
BilIin2 Address:
country club hills utilities
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
'Public Water System Phone:
Private System J
[Preserved With Sodium Thiosulfate 1 II] Fax. -Y? 07
TETON MICROBIOLOGY LABORATORY ID: 0)00969
258 N Water Avenue St.ite 2 Idaho Falls, IDAHO 83402
Office: 208-529-0077 - Pax: 208-522-3797 tetonmicro.com
Client
Sample
Number
Lab
Sample
Nr
Sample
Type
.e
Sampling
Location
Time
Collected
Chlorine
residual
PPM
Original
Sample
Date
Total Oollforms Escherichla Coli
Method Code (P)r.aeaiIJ0eat
j
Method Code (I')re,ent(A)baeat
j LZ (t4&r. / ____ ________ 922313-PA A 922313-PA 1 A
9223B-PA 9223B-PA
9223B-PA 922313-PA
922313-PA 922313-PA
9223B-PA 922313-PA
S-l&cutiat Sample C.CanstructitS1*clel WUntreateScurce) P-iepcot sax !J-uçatream Repeat DDownatieamlRepeat X-Odiier Repeat
Eet (chain of Custody geqund) : (At Original Tap) -
haln-ofCustody Information
Date me:2tW Race RekqAahtd by Date: Tine: Received by
Releitpslebedby Date: Z-7—Received by Relipsi,hedby Due: Tine: Reccwedby
DATErnME RECEIVED:4 ANALYST(3 REMARJ(S:
DATE/TIME ANALYZE: i4 I SUPERVISOR: O
DATE/TI)a READ: u4i LABID#: 11)00969
bend Resuks To

DEQ DI3QPIH

"Dat1 Odet
Dist 6
258 N. Water Ave Suite #2- Idaho Falls, Ii) 83402
• phone[phone]far(208)-522-3797
email: tetonnucrolab(äjgmaiL corn www.tetonmicro.com
INVOICE
Invoice Date: September 13, 2011
Bill To: Country Club Hills Work Order No. 1109115
570 S Yellowstone Ave
Idaho Falls, ID 83402 P0 Number:
TERMS: Net 30 Days
INTEREST CHARGED AFTER 30
DAYS 1.5% PER MONTH
PROJECT. Nitrate
CoIL Dale Sampling Point Sample Description List Price
09/13/11 well #1 Nitrate asN $35.00
09/13111 Well #2 Nitrate as N $35.00
Please Pay This Amount $70.00
258 N. Water Ave Suite #2- Idaho Fails, ID 83402
phone (208)-52 9-OO77fax[phone] Lab ID: 1D00969
email: teton.mlcrolab®gnuiil.com www.tetonmkro.com
INORGANIC CHEMICAL ANALYSIS REPORT For Public Water Systems
FROS Compound Result Units MCL MDL Method Analysis Date Analyst
PRIMARY IOC CONTAMINANTS (Mandatory, except for transient water systems)
1040 Nitrate as N 1.04 mg/L 10 1 300.0 09/13/2011 BWH
ND4ot Detected SUB-AT 125
LAB RESULT REPORTING CODES:
ND = Not detected within sensitivity of instrument PWS Name: COUNTRY CLUB HILLS
---'No analysis performed for this contaminant Work Order#: 1109115
Numerical entry = Detection of contaminant at level
I
Lab Sample Tracking #: T 110911501
Indicated I Date-Time Collected: 09-13-201109:15 AM
Nitric Acid Preevative [ JYES [ NO Sample Type:
Date-time Dropped Off-
Water
09-13-201109:48 AM COMMENTS: Sub-Lab work performed by lAS
EnviroChem, Pocatello, ID. Collection Location: Well #1 LAB # ID 00952 MS-EnviroCheni, warrants the rest Date Reported by Lab: 10-13-2011
results, from accepted analytical work to be of precision Jurisdiction: DEQ
normal for sample type and methodology employeed for each rws Contact Phone: [phone]
sample submitted. IAS-EtwiroChem disclaims any other
warranties, express or implied, including warranty of fitness
for a particular purpose and warranty which the client __________
test results. My analytical work performed mint be ( - S_Sj!iS?r ___
governed by the terms and conditions set forth herein.
258 N. Water Ave Suite #2- Idaho Falls, ID 83402
phone[phone]fax[phone] Lab ID: 11)00969 Ali& email: tetonmicrolab®gma IL corn www.tetonmicro.com
INORGANIC CHEMICAL ANALYSIS REPORT For Public Water Systems
FRDS Compound Recall Units Mi AWL Method Analysis Dale Analvst
PRIMARY IOC CONTAMINANTS (Mandatory, except for transient water systems)
1040 Nitrate as 2.80 rngfL 10 1 300.0 09/13/2011 BWH
ND= Not Detected SUB -AT125
LAB RESULT REPORTING CODES:
ND = Not detected within sensitivity of instnanent
= No analysis performed for this contaminant
Nwserical entry = Detection of contaminant at level
Indicated
Nitric Acid Presevative [ ]YES [ ]NO
COMMENTS: Sub-Lab work performed by lAS
EnviroChem, Pocatello, ID.
LAB # ID 00952 IAS-EnviroChém, warrants the rest
results, from accepted analytical work, to be of precision
normal for sample type and methodology employeed for each
sample submitted. RS-EnviroChem disclaims any other
warranties, express or implied, including warranty of fitness
for a particular pttpose and warranty which the client used
test results. Any analytical work performed aunt be C
governed by the terms and conditions set forth herein.
PWS #: 107 100023
I'WS Name: COUNTRY CLUB HILLS
Work Order #: 1109115
Lab Sample Tracking #: T110911502
Date-Time Collected: 09-13-201109:00 AM
Sample Type: Water
Date-time Dropped Off: 09-13-2011 09:48 AM
Location Tag #:
Sample Collection Location: Well # 2
Date Reported by Lab: 10-13-2011
Jurisdiction: DEQ
PWS Contact Phone: (20*) 529-5000
_4LI(IL
Outsource Chain of Custody and Analytical Request * •
• Project Name: [e-mail]
258 N. Water Ave. Ste 2 Idaho Falls, ID 83402 Office: 2*539.0077 Fax 20& 5223797 •
(411 chAA +i-r inKi\ AnalysisRequest: n•Aa LIfl kfl&aW4 fl.J SflflJ/
Report to: - Shipped by:
Cooler ID: Company
Receipt Tenip: Address I
FA AHO
IIll]
Address
Sampled By: j Phone:
Fax:
PWS# Location Date / Time

?IWO I L4JJJI Jr ( q 11 9 ;(5 Al
Project Relinquished By; 4Da)7e
Adft tetonmicrolab®mail.com
258 N. Water Ave. Ste 2 Idaho Falls, ii) 83402 Office: 208.539.0077 Fax. [phone]
(fill out shaded categories only)
Outsource Chain of Custody and Analytical Request
Project Name:
Analysis Request:
Item 33
Documentation
ml-~UE

H-K CONTRACTORS, INC.
P.O. BOX 51450
IDAHO FALLS, ID 83405-1450
[phone]
OUNTR'{ CLUB HILLS UTILITIES
7' S YELL WST 'NE
J.DAHO FAILS IL 83402
PAGE
6540 1
STATEMENT DAlE
04/30/05
p;Ii
SEEN
CO MTPACIORS, INC.
rL, ly Employer
CoutrIfdi Association
Job F Descriptk
941 1 2-Apr Waterline repair
941 12-Apr Waterline repair
941 12-Apr Waterline repair
941 12-Apr Waterline repair
941 12-Apr Waterline repair
941 12-Apr Waterline repair
941 12-Apr Waterline repair
941itAur Waterline repair
1783 -Apr Patching
1783 -Apr Patching
1783 22-Apr Patching
1783 22-Apr Patching
1783 22-Apr Patching
1783 22-Apr Patching
1783 2Apr Patching
1783i Apr Patching
1783 gfl.Apr Patching
2315 Backhoe 3.50 75.00
4304 Excavator 3.50 103.00
Misc 10 Wheelers 6.50 63.00
Mobilization 2.50 80.00
Labor 6.50 30.00
Foreman 4.00 50.00
Tons Pitrun 91.00 1.65
Tons 3/4"Roadbase 14.00 5.50
2116 Backhoe 1.00 60.00
5634 Crew Truck 0.50 33.00
6112 10 Wheeler 2.00 63.00
7402 Roller 1.00 65.00
15001 Paver 0.50 151.00
18132 Saw 1.00 102.00
Labor 11.00 30.00
Foreman 2.00 50.00
Tons Asphalt 7.00 30.00
Subtotal
Sales tax on material
Total Amount Due
262.50
360.50
409.50
200.00
195.00
200.00
150.15
77.00 $1,854.65
60.00
16.50
126.00
65.00
75.50
102.00
330.00
100.00
210.00 $1,085.00
$2,939.65
$26.23
$2965.88
P.O. Box 51450
Idaho Falls, Idaho 83405
[phone]
Fax [phone]
Units!
of work # Description Hours Rate Total Daily Total
i L i;•
—_TERMS
Due on receipt
QTY
Ii
DESCRIPTION
4/11/05 and 4/12/05 Find and dig up
leaking water line
I]
10:14 AM
Hansen Excavating, Inc.
Invoice
Idaho Falls, ID 83401
i •3877 6041177
Countzy Club Hills Utilities
Ij - Am
INVOICE# DATE
1350 4/18/2005 -
RATE AMOUNT
- 75.00 825.00
1 al preciati; your business. If may help you in the future, please don't
hesi ate to call, Thanks.
- -----.-- -
Total $825OU
E!11E] i

Idaho Falls,daho 83405
[phone]

cow RACTORS nc. Fax [phone]
Equal ( pportunity Employer
Ccuntry Club Hills Utilities
Ex. Units!
Ord r ' Date Description of work Equip # Description Hours Rate Total Daily Total
1613 3-May Repair waterline & valve box 2315 Backhoe 3.50 84.00 294.00
1613 3-May Repair waterline & valve box 4301 Excavator 3.00 105.00 315.00
1613 3-May Repair waterline & valve box Labor 20.00 30.00 600.00
1613 3-May Repair waterline & valve box Foreman 6.00 50.00 300.00
1613 3-May Repair waterline & valve box Misc Valve box & top 1.00 115.71 118.88 $1,62788
2373 15- 'iay Patching R59 Rotler 0.50 97.00 48.50
2373 15-May Patching 5634 Crew truck 0.50 36.00 18.00
2373 15-May Patching 6112 10 Wheeler truck 2.00 69.00 138.00
2373 15-May Patching 15002 Paver 0.50 160.00 80.00
2373 15-May Patching 18132 Asphalt saw 0.50 105.00 52.50
2F,3 1 Patching Labor 16.00 30.00 480.00
233 14M Fatching Foreman 3.00 50.00 150.00
2373 15-May Patching Mobilization 1.00 95.00 95.00
2373 laçing Tons Asphalt 6.00 34.00 204.00 $1,266.00
Subtotal $2,893.88
Sales tax on Mati $10.20
Total Amount Due $2904.08
n Excavating, Inc.
County Line Rd. mv ic 10 Falls, 1D 83401
3677 604-1777
Mike Groth
935 1st St.
Idaho Falls ID. 83401 4
TERMS
Due on receipt
QTY
8
INVOICE# DATE
1519 512/2006
RATE AMOUNT
70.00 560.00
I1I iJi
IL

ll tEM DESCRIPTION

Ex4vation 4/21/06 dig for water line, try to find water
line, no luck, backfill.
I
ji
r '
Ali
iate your business. If i may help you in the future, please doift
o call. Thanks. Total $560.00

tQ
aifivE v
P.O. Box 50660 Idaho Falls, Idaho 83405-0660
November 20, 2006

Mr. Mike Groth
County Club Hills Utilities
370 3. Yellow tutic
: Idaho Falls, 1D 83402
RE: Settlement Agreement
Dear Mike:
I have received confirmation from Don Carey that they are willing to settle the
r the amount of $4,000.00. If you would make arrangements to make the
payable to "Quane Smith Trust Account" in the amount of $4,000 and bring it to
e, I have already prepared the settlement correspondence to go back to their
- Sincerely yours,
LA WJ4ffCE OF BART M. BA VIS
I)!ART lvi. DAVIS
AI,MIT1*O TO PRA CII CE:
Idaho
A,irimatr4eraiCourt,
US Court VIAppeala, 9th (1,
United St4le, Supreme Court
TELEPHONE:
3A.5V4100
l ZS22l33c
Emad babthISmo.net
I
BART M. DAVIS
Attorney at Law
P0 Box 50660
Idaho Falls, ID
83405-0660
[phone]
tatement submitted to: November 03, 2006
:ountry Club Hills Utilities
70 S. Yellowstone
daho Falls ID 83402
in Reference To Complaint and Financial Issues
My T.I.N. is 82-0437975. I do not itemize again. After 30 days ALL ACCOUNTS will be assessed a
iwe Charge of 18% a.p.r., on the unpaid balance.
Professional Services Rendered I IIIkII Amount
r llItIllhIo Office Conference with Mike Groth 131.25 I IIIiHhIII Telephone conference to Don Carey
eMail to and from Don Carey re settlement 43.75
Telephone conference with Don Carey re: settlement options 43.75
10/17/2006 Telephone conference vill I1ke proIanq nail to Don Carey, Esq. re 61.25
settlement
10/26/2006 eMail to Don Carey re status 26.25
7/2006 Telephone conference to Mike dröth' 17.50
For professional services rendered, $323.75
I Balance due $323.75
11
iF -
III11
iIl
II
itement submitted to:
untry Club Hills Utilities
Ln: Mike Groth
S. Yellowstone
ho Falls ID 83402
Reference To:
BART M. DAVIS
Attorney at Law
P0 Box 50660
Idaho Falls, ID
83405-0660
[phone]
Complaint and Financial Issues
December 04, 2006
MyT.l.N. is 82-0437975. 1 do not itemize again. After 30 days ALL ACCOUNTS will be assessed a
F we Charge of 18% a.p.r., on the unpaid balance.
l Services Rendered ces - Ai11hIiai Amount
1111 1111114s Reviewed email from Don Carey re: settlement
.011 III III Wçrkt4 on letter to Mike Croth
flJ ft JI Letter to Mike Roth re: Counter Offer from State Farm Insurance
i'k/i 3/2006 Telephone conference with Mike Groth re: settlement
email to Don Carey re et1ei4nt
11/20/2006 Letter to Mike Groth re Settlement of $4,000
Reviewed email and worked oneo*espohdence
Letter to Don Carey re Settlement Aeie!t
47.50
47.50
66.50
47.50
47.50
47.50
For professional services rendered $304.00
Previous balance $323.75
1 1V3012006 Payment - thank you. Check No. 3138
Total payments and adjustments
Balance due
i
($323.75)
($323.75)
$304.00
BART M. DAVIS
Attorney at Law
P0 Box 50660
Idaho Falls, ID
83405-0660
[phone]
Statement submitted to: January 04, 2007
ountry Club Hills Utilities
Mike Groth
Yellowstone
I daho Falls ID 83402
n Reference To: Complaint and Financial Issues
MjT.I.N. is 82-0437975. 1 do not iemize again. After 30 days ALL ACCOUNTS will be assessed a
Fiance Charge of 18% a p r, on thL unpaid balance
I Professional Services Rendered
Amount
2/13/2006 Letter to Mike Groth e Motion and Order to Dismiss 38.00
For professional services rendered
Interest on overdue balance
4 11
Total amount of this bill
! TcL
Previous balance
Jj )
3I
it Balance due
Your bill is 30 days past due.
$38.00
$4.65
$42.65
$304.00
$346.65
P.O. Box $1 50
Idaho Falls, ID 83405
208-523-660J
INVOICE Invoice No: 2594
Invoice Date: 1012012008
Contract: 800317.
Customer No: 1220
Terms: Due Upon Receipt
Due Date: 1012012008
Application: 2
Cust Ref:
To: Country Club Hills Utilities
570 S. Yellowstone
j Ali
.' Idaho Falls, ID, 83402
Job Information:
Country Club-Water Svc Rpr
Item - DecriotIon Total
1 - Rpr Water Svc from Main to Meter, Rpr 100% LS 4,371.00 4,371.00
Sprinkler Line, Patch
Total Due:
I
jii ij lf you have Questions regarding this billing please contact us at 208-523-6600
j
Ii
4,371.00
14
14 tr
1 ,
14K CONTRACTORS, INC. Remit to: P.O. Box 51450
Idaho Falls, ID 83405
Customer Name: Country Club Hills Utilities
Customer No: 1220 Invoice Number: 2594
Invoice Amount: 4,371.00 Amount Remitted:-
Jib 800317
ountry Club Hills Utilities
All ~jl fff
and Equipment Hrs
10 Backhoe 8.5
2-ton Pickup 2
10-Wheel Dump Tk I
Roller I
Fver I
Operator Labor 27
Láborer 17.5
Supervisor 8
Materials:
Ft a, Couplers
Inserts, Adapter,
f1bow
8 ton J1TjJJJ Total
Rate:
$112.00 $952.00
$43.00 $86.00
$100.00 $100.00
$91.00 $91.00
$177.00 $177.00
$35.00 $945.00
$30.00 $525.00
$75.00 $800.00
$3,416.00
$319.31
$72O0 $516.00
$4,371.31
iIa 1
4
INVOICE
II DENNING WELL DRILLING, INC
IIII BOX 460 UCON, IDAHO 83454
523-4600
1
IL
• M.Lke. G'totk
Ccan-tkJ CLu.b HiJL6 Wa;teA
935 14t ST
Idaho FalLs, Idaho 83401
DATE DESCRIPTION AMOLJrH
1 30 H.P. Pump 225 GPM $1115.00
C'ied.U_(4LL9kUg_used) -500.00
1 Heat Shit.Lnfi Kit 1.50
1 4" x 3" 8w6lvLrig 12.25
SevLc.e._CaLL_ and _La..bo't. 630.00
ToCaL Vae. $1264.15
Ii ii i.pI
:1
Fnil
NT1ACT0RS, INC.
P 0 Bu , 1450
Idaho F tik, ID 83405
208-52 00
INVOICE Invoice No: 3687
Invoice Date: 613012009
Contract: 809136
Customer No: 1220
Terms: Due Upon Receipt
Due Date: 613012009
Application: I
Cust Ref:
To: Country Club Hills Utilities
570 S Yellowstone
Idaho Falls, ID, 83402
Job Information:
Country Club Hills Util.-Pineht
lten - L criotion Units Unit Price Total
ii - VV ler Service Repair 1.00 EA 2,255.32 2,255.32
Total Due: 2,25532
I If you have Questions regarding this bilhng please contact us at 208-523-6600
I
emit i - HK CONTRACTORS, INC. Customer Name: Country Club Hills Utilities
P.O. Box 51450 Customer No: 1220
Idaho Fails, ID 83405 Invoice Number: 3687
Invoice Amount: 2,255.32 Amount Remitted_______________
i §fi 1253 E 9th N
Rexburg, ID 83440
Ii1'k.J[.i
Date Invoice #
7118f2011 401
'1
(
P.O. No. Terms Project
fte

Quantity Despbon Rate Ainouat
11338 So Augusta Dr. - Mk Hoffman estimate 000 000
4 on yd 20.00 80.00
lui h Grade 1 1 hour (topsoil, place boulder) 65.00 65.00
EU! 3 Sgafton 32.00 96.00
reini;d 15 I gallon 13.00 195.00
ip sy tern. netafim (parts/labor) 117.00 117.00
ec' Iñatt 400 sq ft 0.30 120.00
avl 3.7 wasbod rock 3/4"minus 45.00 166.50
wh kit rI 3 hours 35.00 105.00
te 1 hours 35.00 35.00
( 1I LI
*i for your busmess Total $97950
It 14,
Ni
Town & Country Idaho Falls
5800 S. Yellowstone Hwy.
Idaho Falls, ID 83402
208-522-5247
Ticke9498615 CusJt379 Jun 0111
Usr IF Sip 700 Rgls 3 DrIl 3 Time 03:55
Item Number Uty Price Ext
KC621 1 239.60 239.60
X.KC TABLE ROUND
Subtotal 238.60
Tax 14.38
Total sale 253.98
CHARL 253.98
GROTH, HIKE
570 S. Yellowstone
IDAHO FALLS, ID 83401
THANK YOU FOR YOUR BUSINESS
*OUR PROMISE TO YOU*
If we ever disappoint you, please let us
know. We promise to do our best to make
it right.
*PLANT1 GUARANTEE*
All plants are guaranteed for 60 days
from date of purchase* .Garden Advantage
Club members receive 2 years on hardy
trees & shrubs - 90 days on perennials,
annuals, houseplantsl, roses & 'Adventure
Plants'. *Proof of purhase required.
I Limited guarantee- see store for details
1'
H-K Conti actors, Inc. STATEMENT
P.O. Box 3518
ogdenur 84409 HI[
Pap
CONTRACTORS INC
Account No
• Ili 07/31/11
outrub Hills Utilities
570 S. 'Yellowstone
Idaho Falls, ID 83402-
I .I,1tll.1l11IHia,liIntl,
AccountName
Country Club Hills Utilities
ent Date age
07/31/11 1220 1
To ensure proper credit, please return
this portion with your remittance
ice !nVOICC Cd Amount
e Due Balance Due
A Fsnan!aIe ' 1.50% per month (amual percenta0e fate of 18.00%) will be charged on at past due accotmis

Dote C d Invoice Description

107/15/1'1 I 7391 1 Patch Hoffman resden 2,171.90
Co ITRACTORS, INC.
11.0. Box 51450
Idaho FaUs. ID 83405
208-1 ,23-6600
II To: Country Club Hills Utilities
570 S. Yellowstone
Idaho Falls, ID, 83402
ken! criotion
1 - W. der Main Repair, Augusta
INVOICE Invoice No: 6625
Invoice Date: 12/1/2010
Contract: 810222.
Customer No: 1220
Terms: Net 30 Days
Due Date: 1213112010
Application: I
Cust Ref:
Job Information:
Country Club Utilty-h2o Augusta
Units Unit Price
0% LS 2,850.35 2,850. 5
Total Due: 2,850.35
If you have Questions regarding this billing, please contact us at 208-523-6600
Paymcntt i full is due Net 30 days 1)in invoice date In the event payment is not made when due reasonable collection fees lien fees and attorney lees with or without
suit, toget ter with I 1/2% per month IM4AW9 CUARGI which is an ANNUAL PERCENTAGE RATE of 18%, will be assessed until paid.
" \ INVOICE
DENNING WELL DRLLING INC.
I BOX 460, UCON, IDAHO 83454
523-4600
)I i1Ii
Mile aDffi
ryC2th Wabw
935 1st Sbmet
IcED Us, ID 834w
8/31/211 well#1
Item Description Amount
1 30 H.P. Riip 460 V 30 $CI95.00
1 tirk Kit 9.50
, 750.00 vke CM a Ixr
Tital DM $775450
I
I
t
C
0
1d
co
Item 34
Documentation
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Item 40 & 42
Documentation
USA 32
COUNTRY CLUB HILLS UTILITIES RETURN STUB blI Ae6ESSçQ1RE1CTtON
570 S. Yellowstone Ave;,r
Idaho Falls, ID 83402 CURRENT BWNG DATE
000 529-5 , .
METER _______ ;_• PREVIOUS CURRENT CONSUMPT DSCRIPTrON AMOUNT
Previous Balance $ 52.00
Payrnent 52.00
Past Due Balance
60-90
90 Over
806785 6852421 45639 Meter 9.40
Seasonal Water
Water 17.00
Sewer 35.00
05/01 thru 05/31/12 PAYTHS _7vr2V2>
JUN 19 J
COUNTRY CLUB HILLS UTILITIES RETURN STUB ADDRESS CORRECTION
570 S. Yellowstone Ave. WITH REQUESTED
YOUR PAYMENT Idaho Falls, ID 83402 CURRENTeIWNG DATE
529-5000 MAY 02 2012
PrevicusBelance $100•00

Peyrnerrt .00
30 Da Past Due Balance 52.00
48.00
90-Over
Collection Fee 20.00
1281 0( 0 1200C Meter .00
Seasonal Water

Water 17.00

Sewer 35.00
04/01 thru 04/30/12 PAY THIS
AMOUNT l$172.00 SERVICE PERIIDD MAY 1 6 2012 PAST DUE AFTER
JASON CRI.SON
2172 E 113 S
]DAIL) FAILS, ID 83404
KIM SETZERS rf,,i FALLS, ID 83404
Item 43
Documentation
rd ______ • 5O SO. YELLOWSTONE AVE.
IDAHO 'ALLS, IDAHO 83402
UTIIIIIOS
- PHONE [phone]
SUMMARY OF RUJES ,AD RGULIONS OF THE•
PUBLIC UTILITIES COMMISSION
GOVNZNG CUSTOMER RELATIONS OF NATURAL GAS,
ELECTRIC AND WATER. PUBLIC UTILITIES
'UNDER THE JURISDICTION OF THE IDAHO PUBLIC UTILITIES COMMISSION
A utility may terminate service to a customer without
his/rpermission after adequate notice for the following
reaso:
(a)Non payment Of delinquent bills.
(b)Failure to abide by the terms of # payment arrangement.
(C) Misrepresentation of identity.
(d)Unauthorized diversion or use of the utility service.
(e)A situation exists thAt is immed1ately dangerous to
life, physical safety or property.
(f)To prevent a violation of federal, state or local
safety or health àodes.
(g)If ordered by any court, the Commission, or any other.
duly authorized public authority.
(h)Violation of any other rules of the utility on file
with and approved br the Idaho Public Utilities
Commission which adversely affects the safety of the
• customer, other persons or the integrity of he
utilities delivery system.
(1) Non sufficient funds check.
Actions customer may take. .to avoid' .termination:
(a) If you cannot pay your billing and a member of your
household is seriously.'ll or there is a medical
emergency, Country Club Hills Utilities will postpone •
termination of service for thirty (30) days. A written
certificate is 'required from a licensed physician or
public health off iciàl stating the name of the person
who is ill, the relationship to customer and the name,
title and signature of the person certifying the
serious illness or medical emergency.
• : ' •L,, . • •
• !
(b)An informal or formal complaint concera"ba I eg,( termination may be filed witJi.. he ut4 .4
Country Club Bills Util1tie
570 South Yellowstone Avenue
Idaho Falls, Idaho 83402
Telephone: [phone]
Or if you are unable to contac1he utility you may
file with the Idahot'ublie Utilities Commission,
P. 0. Box 83720 .p.isé' idah0832O Toll Free
No. 1-800-432 ;g49.
(c)Make payment arrangements with the utility company.
-Dt
Complete sets of Customer Rules &Regu1ations are on file
with Country Club Hills Utilities and the Idaho Public Utilities
Commission.
*tj 4
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30 b nLfld MO. :Z ?
t1 I ! fJ 'tt) flWO) ,
Kb
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2.
I
Item 44
Documentation
50 SQ. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
- fl?tflatfl I ' a fl
• A utility may terminate service to a customer without
his/r permission after adequate notice for the following
reasone:
(a)Non payment Of delinquent bills.
(b)Failure to abide by.the terms of IL payment arrangement.
(C) Misrepresentation of identity.
(d)Unauthorized diversion or use of the utility service.
(e)A situation exists that is immedIately dangerous to
life, physical safety or property.
(f)To prevent a violation of federal, state or local
safety or health bodes.
(g)If ordered by any court, the Commission, or any other,
duly authorized public authority.
(h)Violation of any other rules of the 'utility on file
with and approved b the Idaho Public Utilities
Commission which adversely affects the safety of the
customer, other persons or the integrity of the
utilities delivery system.
(i)Non sufficient funds check'.
Actions customer may take. to avoid termination:
(a) If you cannot pay your billing and a member of your
household is seriousl-y.11-or there is a medical
emergency, Country Club Hills Utilities will postpone
termination of service for thirty (30) days. A written.
certificate is 'required from a licensed physician or
public health official- stating the name of the person
who is ill, the relationship to customer and the name,
title and signature of the person certifying the
serious illness or medical emergency.
1•..,
gab
(b)An informal or formal complaint concerftqhe• .
termination may be filed wtJhe utij
Country Club Hills Utilities
570 South Yellowstxne Avenue
Idaho Falls, Idaho 83402
Telephone: [phone]
Or, if yqj 4 are unable to contacthe utility you may
file wj' the Idahoii4ljc Utilities Commission,
P. 0. Box 83720, Bcie Idaio"83720. Toll Free
No. 1-80Q-432-O$9
(c)Make payment arrangements with the utility company.
Complete sets of Customer Rules on file
with Country Club Hills Utilities and the Idaho Public Utilities
Commission. wit
j
c
J
A. €ct;ft LCU *JiO4$I/* t.t
u• edo v*s
E4Whb
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jqXb
$4 saw
0,(11 J JfiNWAOk . m
L1O 2
.t blwdoatU04.
Tk if
. tt •m)
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It.
2.
Item 46
Documentation
-
570 SO. YELLOWSTONE AVE.
IDAHO FALLS, IDAHO 83402
DUrmTw tinni r,1 0 A1A1
ciiiitrdt, lulls VIII iiies
FINAL. NOTICE
ACCT NO:
SUBJECT:
You are hereby notified that you are delinquent in the payment of
charqes for Water Service provided by COUNTRY CLUB HILLS UTILITIES.
Our records indicate that the balance of your account now stands
at$
If this balance is not paid, or if payment arrangements are not
made by the Final Date of , then your WATER SERVICE WILL
BE DISCONNECTED WITHIN SEVEN DAYS after the final date.
To avoid termination you must contact COUNTRY CLUB HILLS UTILITIES
before the final date to make arrangements or pay in full.
Termination will be delayed or thirty (30) days by providing
a physician's certificate stating a medical emergency exists.
You may file a complaint with the Idaho Public Utilities
Commission, P. 0. Box 83720, Boise, Idaho 83720-6000
Phone: [phone]. Your service will not be terminated
prior to the resolution of such a filed complaint.
Termination of service in no way relieves you of your obligation
to pay for all services prior to termination.
* There may be a charge for restoration of service following
termination of service ( $14.00 during office hours, $28.00 all
other times.)
COUNTRY CLUB HILLS UTILITIES WILL ASSIST YOU BY MAKING PAYMENT
ARRANGEMENTS not requiring immediate payment in full, if you
contact us to arrange such a payment plan.
Remember, your water service will terminate within SEVEN DAYS
after the* Final Date unless you act before the Final Date.
COUNTRY CLUB HILLS UTILITIES