Cambridge Phase 1-LR 940921WATER BACTERIOL~'¥ Texas.._.Department of Health
Form No. G-19 (Rev.' ] Bur("?
Laboratories
Sample No. ' ..... F[eported ! '~_~/.,/, /
~ . ~. ,J:)o.not mark abov~t this [i~&-- Ple~s~ print witft ba~poirft'p~h (Jr t~pewrite~.
Water System I.D. No. NAME OF WATER SYSTEM
'POINT OF COLLEC'~IDN COUNTY
NAME '
ST.E ADD.ESS (P.O.
CITY ZIP CODE
Date and
Collection
MONTH DAY YEAR TIME AM,PM COLLECTED BY
SAMPLE IS WATER SOURCE
TYPE OF SYSTEM (Public Systems Only)
[~'Public [] Dairy ~[Oistribution [] Raw [] River [~-'t.ake
[] Individual [] Bottled ,,~onstruction [] Repeat [] Well Well Depth
[] School [] Special Chlorine Residual ~
'Ownership or other information:
LABORATORY REPORT (Do not write below)
Water of satisfactory bacteriolegical quality must be free from Coliform organisms
Coliform Organisms ~[Not Found
[] Found
[] Total coliform group
[] Escherichia coil
'-" : : ~-'~ -~ [] Repeat s~ples require- -~ 'i ~ '- ':~
[] Unsuitable -- See below
DENTON MUNICIPAL LABORATORY
, A~. NU~F--R 48130
- UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT '"
[] Sample too old. Sample not received [] Quantity insufficient for analysis
within 30 hours of collection (100 mi. required)
[] Date discrepancy or form incomplete [] Heavy (silt/bacterial growth) present,
(See encircled item) possibly compromising test results
[] Leaked in transit (/~) ~~~ '
[] Other ~'~'~.,., }.~ ' 1 ~,...,'(