Alford Media-LR 980212 TA!~NT COUNTY PUBLIC HEALTH~ LABORATP""
1800 University ~., Ft. Worth, TX 7610:7
WATER BACTERIOLOGY Lab Ho. 48010 (81,7)871-72'45
Date and Time Rec'd. Date
Sample No. Reported
"'; dj N*~ ~i~lrk-J~bove This Line .-.-.Please Pri~l~m~-~th~B~.LP~)iN'l' FlEa d ~P~RITER' '
HAME OF W~ER SYSTEM ~ ~
POINT OF COLLE~IONISAMPLE DESCRIPTIOH
RESULTS STRE~ ADDRESS (P.O. Box}
CI~ ~ Code)
PHONE ~ COUN~
Water System I.D. No.
"'"'"' Iolql/Iql l l Io1'4: I g I-d R I
Time of
Collection Manth Day Year TIME AM/PM Collanted'6y
"* TYPE OF SYSTEM SAMPLE IS WATER SOURCE
Public I-]Dairy r-lDistribution r-lRaw r--IRiver /J~lLake
Individual [] Bottled ,~]lConstruction [] Repeat [] Wall
[]School []Vended ~L_lGlycol/SweettChill Water Well Depth
[] Other Chlorine Residual
,A~ditiehallnformation: (~T"/~ ,~t.~ ~)~I,C~F~; ~i~"r'E~.
LABORATORY REPORT (Do no write belmg)
TECH
MMO-MUG
PresencelAbsence
Coliform Organisms
oundOt Found
[] Total Coliform group
[] Repeat samples required
[] Unsuitable .. See below
Membrane Filtration (MF)
Coliform Organisms
[] Not Found
[] Found
Total Coliform/lO0 mi
£co/i/100 mi
Fecal Col/forms/lO0 mi
[] Unsuitable -- See below
MMO.MUG
Most Probable Number (MPN}
Coliform Organisms
[] Not Found
I'-) Found
Tetal
Celiform: MPN/IOOml
£co//: MPNIIOOml
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Sample too old. Sample not received
within 30 hours of collection
[] Date discrepancy or form'incomplete
(See encircled item)
[] Leaked in transit
[] Quantity too great to permit agitation
[] Excessive chlorine residual: .mg/L
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy (silt/bacterial growth) present,
possibly compromising test results
[] Sample received on Friday
[] Other
H-220 GPC-2190