Asbury Manor-LR 971215 (3) Na of Water System i- County
....
· A..,.,~ P M "~
Point of Collection Collecled By Date Time -.._'
(Mo/Day/Yr) ,._.-:
Bi,lng/ NAME ~ ~o~- ~ ~ (.. ~,,./
Address: STREET ),' ~'~ ;
TELEPHONE¢ N~) "~' ?'O~'~¢PC'°de)
Waler System Identification Number
TYPE [] Public [] Individual
SYSTEM: [] Other ~ ~
SAMPLE
Dislribution [] Special ~;~C~onstruction
IS:
[] Repeat for sample # ~-~
[] Recheck for sample #
[] Other "
WATER [] River [] Lake [] Well
SOURCE:
Well deplh Chlorine Residual
ANALYTICAL METHOD & RESULTS:
Present:Absent: Total Cohform Present
Fecal Cohform Present ~
MP.N Total Coliform /100ML --~
Fecal Coliform. /100ML :
Membrane Filter/Fecal Coliform: 1st Dil.__/__ml 2n~l ;__mi
Avg __ ,' mi
Unsuitable For Analysis:
[] Form Incomplete (see encircled item)
[] Sample too old, not received within 30 hours of colleclion
[] Excessive chlorine present in sample
[] Unsuitable container
[] Heavy, non coliform bacteria/sill present, possibly obscuring and compromising lest
[] Quanlity Ioo great to perrnil agitation /'~"
[] Quantily insufficient for analysis (100 mi minmum)
[] Other
,,,~nalyzed by
Walet of sat~sfecto~ ba~-..rologfcal qual~y shoul¢l be free from Coliform Orgamsms.