ST8804-LR 910214 (3)WATER BA~ ,,OLOGY Tlxea Department of Health
Form N~. G.le (rS,,. ,0.~) ~ of
Date and ~'d .,.. , Dire - - ..... ·
Sample'No.--~"~";. " Re~ed
~ ~l mlrk INvI Ihll lIN -- ~.. print wllh ~ll~lnt N~ ~ t~wrlt~ ',
NAME OF WATER ~YSTIM : ~UNTY ..'
BEND ~ESULT5 TO: ' ' ' "" . ':'
NAME -'
FPFI PP~PF~I I~l ~F~P~kl I i .
I ICPf'~l~F F'I I I I I I IT=.I7FPI/~I'I I I I I _.~
5AMPLE IS ; WATER ~URCE
TYPE OF SYSTEM ~p~m,c sv~t.ms
[~ Public ~ DiI~ ~ DiBtribution ~ RIw ~ River ~
~ Individual ~ ~ttled ~ ~ns~ructlon ~ Check ~ Well Well~pth
~ School ~ Specl&l Chlorine Residual
Ownership or other Information: '
~IORATORY RE~ORT (~ W ~ ~) '-.'
Water of satisfactory bacteriological quality should ~ free from ~llform organisms
~:h ;' [;~.~LIH ''.'.~
::- ~; ~0[~
M F Coliform ~unt (presumptive) Ileal.
MF Coliform ~unt (verified) Ileal.
UNSUITABLE FOR ANALYSI6-~LEASE RE.MIT ......
-j
~ Sample too old. Sample not mcel~ ~ ~ly one ~mple ~r time and ~inl of coll~tion
wllhln ~ hours of ~oll~tlon r~ulr~ ':
['.] Date discrepancy or lorm Incomplete ~ Heavy (slltlbaclerlal growth) (with eollforma) prl~nt,
(See encircled Item) ~allbly obscuring and compromlllng lest
[ ~ Quantity Insufficient for analyele ~ Quantity t~ great to permit agitation
(1~ mi. minimum)
[] Leaked In transit ~ Other
~ Not an approved ~ontalner