PA9901-LR000412 4
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CITY OF LEW..,VILLE LABORATORY - WATER BAC ...:RIOLOGY CITY OF LEV► _MLLE LABORATORY - WATER BAt. _.RIOLOGY CITY OF LEA �VILLE LABORATORY - WATER BAS ERIOLOGY
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Name of Water System County m . N ame o f W a t er S ystem C oun t y a m . - N ame of Water System County o 07 r- iz, a c w a brK z
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�/ c 7. �,-- J" v -it )�' Q C fir AM/PM 6
Point of Collection Collected By Dale Time d t 1 % Point of Collection Collected By Date Time , P oint of Collection Collected By Date Time m (( t` 1 .
t (Mo /D ay /Yr� 0 (Mo/Day/Yr) /� 0 (Mo /Day /Yr) . t p
Billin NAME • 1 Ci J Billin NAME ) ��.�r� & G W , °_`
g ^ m '� 9��''�l =fit '� / !! /cam D X~ Billing NAME �a�TK C1-.//2i z
Reporting R . co } Reporting m __.�
Address: STREET QC) \ti! 1 • 1 >1 . - --� A STREET��f� �f '� /2YN1.- ` r' Reporting STREET l2G) i i =j-i � ?'i )07 .5X 9 = ° ,
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CITY t w ' 1 ( .CST TEXAS e)07 *" a CITY ,c_I) S7 TEXAS ...k2.5
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� 1 CITY f2 Sr T TEXAS i
TELEPHONE(c l) £""+ TELEPHONE(, 7 ) ,2L/S ?) i pC°63) TELEPHONE( )7) '"Il 0 2 yip Code) C.--
Water System Identification Number O w Water System Identification Number •
O w r " Water System Identification Number SD • co
TYPE • Publ o o TYPE m TYPE o 0 o I
ic CI w 'w m < ub lic ❑ Individual w w w
OF OF . o o i OF ❑ P ublic ❑ I ndividual 'a e o
SYSTEM: ❑Other _' � z .. o m ! SYSTEM ❑ Other 3 Z o Iii Z
I w SYSTEM: m w o
SAMPLE on > I SAMPLE r _ D Z
❑ Distribution ❑ Special tion ' 3 ❑ Distribution ❑ Special ❑ Construction ' 3 SAMPLE W c
w n w n cr ❑ Distribution ❑ Special ❑ Construction w • 33
IS. to IS: N ¢ m IS.
❑ Repeal for sample # o ❑ Repeat for sample # r o a �. m
w A m 4 ❑ Repeat for sample # v, o
w f rn w f m ❑ Recheck for samp # m o rn
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❑ Recheck for sample # m a ❑ Recheck for sample # m a
❑ Other .c ❑ Other <. ❑ Other rn
E m m
WATER ❑ River a ke ❑ W ell WATER ❑ River ❑ Lake ❑ Well WATER
SOURCE: SOURCE: ❑ River ❑ rare ❑ Well
Well depth _Chlorine Residual Well depth _Chlorine Residual • SOURCE: Well depth _Chlorine Residual .
ci o o p c
ANALYTICAL METHOD & RESULTS: 3 ANALYTICAL METHOD &RESULTS: 3 �-
_.� w w 3 ANALYTICAL METHOD & `° 3
Present/Absent: Total Coliform_; Present absent ; a Present/Absent: Total Coliform P Ab a ? PresenUAbsent: Total Coliform Present ahr r .. c
—�� -i N Present sent ----!
y,
(Colilert) E: O�Ti -'� Present Absent (Colilert) E:Coli. Present nt (Colilert) o I. /100ML c
M.P.N. Total Coliform /100ML m M.P.N. Total Coliform /100ML D M.P.N. Total Coliform /100ML
(Colilert) E. Coli. /100ML a, (Colilert) E. Coli. o Colilert
( ) E. Coli.
Membrane Filter /Fecal Coliform: 1st Dil./ ml 2nd ml 0
a Membrane Filter /Fecal Coliform: 151 Dil. / ml 2nd ml Membrane Filter /Fecal Coliform: 1st Dil. ml 2nd / ml , am \
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Avg__ ._/ _ml Avg __/ __ml
. Avg. - - - -/ _ml " ", ?,
Unsuitable For Analysis: Unsuitable For Analysis: Unsuitable
Y � Y lnsuitable For Analysis: . '
❑ Form Incomplete (see encircled item) ❑ Form Incomplete (see encircled item)
❑ Sample too old, not received within 30 hours of collection ❑Form Incomplete (see enc item)
❑ S ample too old, not received within 30 hours of collection ❑Sample too old, not receive w 30 hours of collection
❑ Excessive chlorine present in sample ❑ Excessive chlorine present in sample
❑Excessive chlorine present in sample
❑ Unsuitable container
❑ Unsuitable container
❑ Unsuitable container
❑ Heavy, non coliform bacteria/silt present, possibly obscuring and compromising test results ❑ Heavy, non coliform bacteria/silt present, possibly obscuring and compromising test results ❑ Heavy, non coliform bacteria/silt present, possibly obscuring and compromising test results
❑ Quantity too great to permit agitation ❑ Quantity too great to permit agitation
❑ Quantity too great to permit agitation
❑ Quantity insufficient for analysis (100 ml minmum) ❑ Quantity insufficient for analysis (100 ml minmum) ,
t ❑Other r' LA , r ❑ Othertity insufficient for analysis (100 ml minmum) =1 j
❑ Ot ' ,
Analyzed by Analyzed by Analyzed by
Water of satisfactory bac:erological quality should be free from Coliform Organisers. Water of satisfactory bac:erological quality should be free from Coliform Organisrrs. Water of satisfactory bac:erological quality should be free from Coliform Organisms.
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