YMCA-LR020221 N.
CITY OF LEWISVILLE LABORATORY-WATER BACTERIOLOGY
Na o atrer ystem County to e/ :L.: 1 k7, pr -
CCU fi: Lt/- ; - i. . ../iU .10•7r)AM/PM •
Point of Collection Collected By Data Time :.J cn
C A (Mo/Day/Yr) k..^1 4 _ O
E--1 al-
Billing/ NAME SI p7r7>'/ / , 1/.` /- I 3
@porting STREET / if /��Yl �;i
ress: _ m
CITY fir//p S TEXAS Tr'x r.Ss'L?(t
P.
TELEPHONE(Di ),QS.i /�. ; (�CodB)
Water System Identification Number C__.,
a, m m
TYPE E Public ❑ Individual - if S
SYSTEM: ❑ Other -a+ Z •:1
v
_ > 3 Z
SAMPLE ❑ Distribution ❑Special Construction
fly
IS: . .co z
❑ Repeat for sample# :_-0
A
# F co
��_ ❑ Recheck for sample# i;,j f ...
❑ Other t�P a
f t.) m
WA R ❑ River ZLake ❑ Well
SOURCE:
It Well depth Chlorine Residual ,.
& RESULTS: "' S §
m
- PfesentLAbsent: Total Coliform J Present •� Absent a
(Colilert) E:Coli. Present Absent —I w
M.P.N. Total Coliform /100ML ,_
/100ML 33
(Colilert) E.Coli. t,-.) $
Membrane Filter/Fecal Coliform: 1st Dil. / ml 2nd__/ ml •--♦ a
Avg. / ml •
t-.�
Unsuitable For Analysis: .iw'
❑ Form Incomplete(see encircled item)
❑ Sample too old,not received within 30 hours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy,non coliform bacteria/silt present,possibly obscuring and compromising test results
❑ Quantity too great to permit agitation 0❑ Quantity insufficient for analysis(100 ml minmum)
❑ Other
Analyzed by 7
Water of satisfactory bac'srologieal quality should be free from Coltlorm Organisms.