ST8804-LR 910214WATER BACTERI(3~Y /~x.. De.idms., of
Form No. G-19 (rev. 10-84~ .i. 4urMu
Oateand'~d : '.'..:,..:-. . ..... ~ Date --...'~. ·
5ampWNo.'~"~ "' ' ~e~ed ..
~ not ~k I~ IMI I1~ -- ~ ~rl~t wll~ ~ll~ln~ ~n ~ ty~wdt~ ...... ·
:'"
NAME ~
I~1: I~ i lml~ l~lok le lylrl I5lrl I I i ! II I I Il
STREET ADD~E~ 1~.0. ~1"
Icl~F''I.''I~ I~1 I I I I I I ITx.!~l~'l~l/~l'l I I I I
8AMPLE I~ WATER ~UR~E
TYPE OF SYSTEM ipu~,c sylleml Only)
~:~ Public~ ~ Dairy ~ DI.trlDutlon ~ RIw Y ~ River
~ Indlvl~ual ~ Bottled ~ ~nltruction ~ ~heck ~ Well Well~pth
~ ~ Special
L~ School Chlorine Residual
Ownership or other Information:
W~ter of s~tisf~ctory bacte~tol~lc~l 9u~tlty should ~ fr~ from ~lifo~m
~OI~T WOE'tit CI~ XD~LT~
~EPfiRI'UENT LABO~/~TQ~
MF Coliform ~unt (presumptive) /1~1.
MF ~llform ~unt (verlfl~) /l~ml.
UNSUITABLE FOR ANALY5IS-PLEA~E RESUBMIT ' ':~ ' ": ' '-. ' '
~ Sample t~ old. 5ample not r~eiv~ "~ Only one s~mple ~r time and ~lnt.of collation
within ~ hours of collation r~ulr~ ~
I h lib
~ Date discrepancy or Iorm Incomplete ~ Hea~ (siltlb~cter ~1 gro~ ) (w oolUorm~) present,
(S~ encircl~ item) ~sibly ob~codng ~nd c~promi~ing teat reaulta
~ Quantity Insufficient for anllyala ~ Quantity t~ greet to permit agitation
(1~ mi. minimum)
~ Leak~lntranslt ~ Other
~ Not an eppro~d container