ST8805-LR 890724 (3)CONSTRUCTION
CO.,, INC.
515 NO. KEALY AVE. LEWISVILLE, TEXAS 75067 (214.) 436-4566
Form No. G-19 {rev. 10-~ .
Date andTime Rec'd
Sample N~ ~.
......
NAME OF~A~ER SYSTE~ J
SEND RESULTS TO:
NAME
SYREET ADD~-ESS (P.O. Boxl ' -
POINT OF COLLECTION COLLECTED BY MONTH
SAMPLE IS W.~.TER SOURCE
_~E OF SYSTEM IPubl,c Systems Only)
I/~"PuDlic [] Dairy [] D_istrib.~ion [] Raw [] River [] Lake
[] Individual [] Bottled LJ~nstfuction []'Check~ ~ [] Well Well Depth__
[] School [] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below)
Water of satisfactory bacteriological quality shou Id be free from Coliform organisms
TIME AM/PM
Coliform Organisms [] Found '~Not Found
~-~ /lO0ml.~T %
MF Coliform Count (presumptive)
MF Coliform Count {verified) /lOOml.
UNSUITABLE FOR ANAL~('~iS.PLEASE RESUBMIT ?::
[] Sample too old. Sample not received
within 30 hour' of collection
[] Date discrepancy or form incomplete
(See encircled item)
[] Quantity insufficient for analysis
(100 mi. minimum)
[] Leaked in transit [] Other
[] Not an approved container
[] Oniy one sample per time and point of collection
required
[] Heavy (silt/bacterial growth) (with coliforms) p~;esent,
possibly obscuring and compromising test results
[] Quantity too great to permit agitation
WATER BACTER,. · ,)GY
?orm No. G-19 (rev, t0-84}
Date and Time Rec'd, ,; ;;~
' Sample No,
Do not m
~ ~ ...... i ~ i ; ~- ~*~ TexasDepartrnentofHeeith
~ j I I ~' ~ '~ Bureau of Laboratories
Pe this line -- P~O*,Tr~t W.L~. ~lntlpen~ oT typeWriter
NAMEO?W~RSYSTENI / COUNTY - ~' '
SEND RESULTS TO:
STREET ADDRESS (P.O. Box)
--I./ i x.:vl l lJl l-I. I !. I ]
CITY / / ZIP CODE
POINT O~I~OLLECTION COLLECTED BY MONTH DAY YEAR TIME AM/PM
Water System Identification Number
SAMPLE IS
_~'v'~=.,~ OF SYSTEM (Pubhc Systems Only)
L~-Public [] Dairy _ I-- Distribution [] Raw
[] Individual [] Bottled [~--'~struction [] Check ·
[] ~,chool [] Special
Ownership or other information: ~J(~ff~/ /[ ~'~r~ 5~ r
LABORATORY REPORT (Do not write below)
Water of satisfactory bacteriological quality should be free from Coliform organisms
WATER SOURCE
[] River [] Lake
[] Well . Well Depth
Chlorine Residual
OEPA RTMENT
Coliform Organisms [] Found '~ Not Found ~IR~.~.~'
MF Coliform Count (presumptive) (~ /100mi.
MF Coliform Count (verified) I100ml.
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Sample too old. Sample not received []
within 30 hours of collection
[] Date discrepancy or form incom~)lete []
(See encircled item)
[] Quantity insufficient for analysis []
(10(] mi. minimum)
[] Leaked in transit []
[] Not an approved container
Only one sample per time and point of collection
required
Heavy (silt/bacterial growth) (with coliforms) present,
possibly obscuring and compromising test results
Quantity too great to perm_it agitation
Other