Asbury Manor-LR 971215CITY OF LEWlb. ,LLE LABORATORY- W~TER
f Water System County
Poin, of Collection Co,lecled By Date Time
(Mo~Day~Yr)
Repolling ~ ~:~. ~.~ ~ ~ e~/~
Address: STREET
o,Tv f TEXAS
TELEPHONE{ ~7 } ~7, E~A~~)
waler ~stem Idenli[~lioo Number
O Public O Indiv~ual
8YSTE~: ~ Other
SAMPLE ~ Distribution ~ Special ~onstruction
IS: ~ Repeat for ~mple ~
~ Recheck for sample ~
~ Other
WATER ~ River ~ Lake ~ Well
SOURCE:
Well depth Chlorine Residual
~mson~'~sent: lotal Goh~orm Pmsem
Fecal Coliform Pmsont '
M.P.N. Total Coliform ~1 ~ML
Fecal Coliform :I~ML
Membrane Filter~Fecal Colifo~: 1st Dil.__ ~ mi 2nd
Avg ~ mi
Unsuitable For Analysis:
~ Fo~ Inco~l~e (~ endrcbd ilem)
~ Samp~ I~ old. not r~ w~hin 30 houm of ~ll~ion
~ Ex~ve chlodne pre~nt in ~mple
~ Unsu~ab~ contai~r
~ Heaw. non ~li~ ba~ed~all pre~nt, po~ibN ob~uring a~ompromi~ng
~ Quanl~ I~ ~t to ~rma a~tation
Ouanli~ insuffidenl for anaN~s (1 O0 mi minmum)
~ Other
Analyz~ by
Wat~ ot ~t=facto~ ~srol~l qual~ sh~ld ~ fr~ from Coliform Organ=~.