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Bellacere Addn-LR130905
DR: JKING WATER (P/A) COLIFORM SUBMISSION/REPORT FORM , z '• Tarrant County Public Health Test results' couN? North Texas Regional Laboratory 4' .4::::::. requirements c 4,..-- P Ve 1101 South Main Street,Suite 1700 r:Please° tirripte# 'all°applit abl ,informa#iort requesteiLtrsldu r; Use:tndekbte ink fy to corstp7st - ..' ;r,� ',, 4e: of NELAP PWS ID#: •N A`4' �� ,y-m; Fort Worth,TX 76104 unless stated Publics Phone (817)321-4778 otherwise. (Must be 7 digits;include all zeros) •* .K Water *„' Fax(817)321-5378 NELAP Certificate#: Systems PWS Name: /�if∎oft elty),_�,�_/r��s +iA� TCEQ Lab ID:480101 USEPA Lab ID:01471 7104704339.12.4 7 -.r_fp*-Boltg RYUSEVNI; DO:NOT`-MARKizr{f g;RIGHTOFTHEBQt )`CENTERLINE Only: County: Sample Iced? — Received Date/Time _ - Name: n ' X'e s No By: Received: i 1` F w Address: 6 tL _1. 1 31...0__1$ If no,temperature Tested Date/Time � IJEJ�C, ALL� f M at receipt? By: /V'/ Tested: �i1 £ 35'pr.cu t City: cif-�j. \ ' `f '•v{{{iii 1. Y�/ "., Tx State: 'j-� Zip: I ) oC ReBorted AA L Reportede e`i`r," r 4 Phone#: e\-7 y C_1�G{ Fax#: 9/ 7 $j ' -• � Report Approval ✓' <� / Signature: Name: ) �/{t f tiz 1 9 nature: Terry MarG� J �7 Approving ❑ Bacon ❑ Lewis Date of Sampler Contact#: ° / ❑ Owner ❑ Operator ❑Other: Technical V yti P✓ t Diane Nancy Approval: hx Please Circle Appropriate System Type: Please Circle Appropriate Water Source: Manager Hardin ❑ Turnage A Groundwater Surface Water Groundwater with Ittifeittiri,l 4 2, .i Cab esuiW Public (Private/ BottledNended Surface Water Influence ' efcruat umie e , 1t4 reaenlyrampi t sele abOiaO[ f(Well) (Lake,river) Sampt r nffica#an Caftected `°SamPto:Typ T t 5'only _ Fre e Tpiease tteMethod SM§223' i Srilpie _ Use a specific address,location,or description Date Time o — Include Lab ID of mg/L t++olilert 18 Presence=Apsence.Format .W D - — is Previous Positive ` For PWS samples,do not use site#only,include Y a a on All Samples Total Coliform E.coli lVlrnlber �+ Pease circle 3 a ❑ Total Rejection a� address;for PWS raw wells,use Source ID#; Ex. o 0 r AM or PM ; cn ix Related to the mg/L Criteria# '` G1234567A o ci Original Sample Present Absent Present Absent (16°1 .fib r`->,� q 3 13 /Jl.q ❑ cal❑ ❑ ❑ .2,3 0 ❑ [ - am pm ❑ ❑ ❑ ❑ ❑I 111 [1] El am 1 pm ❑ ❑ ❑ ❑ ❑ i El El El El am pm ❑ ❑ ❑ ❑ ❑ i ❑ El El El am pm ❑ ❑ ❑ ❑ ❑ , ❑ ❑ ❑ ❑ am 1 pm ❑ ❑ ❑ ❑ ❑. ❑ ❑ ❑ ❑ am pm ❑ ❑ ❑ ❑ ❑ I El El ❑ El am pm ❑ ❑ ❑ ❑ ❑ i ❑ ❑ ❑ ❑ am pm ❑ ❑ ❑ ❑ ❑r ❑ LI ❑ ❑ am I ❑ ❑ ❑ ❑ pm DE11:11210 :Coliform P/A 'tllrauitable SartptArtatyisis* 1) Sample Too old. Not received within 24 hours of collection 3) Excessive Chlorine Residual(>10 mg/L) 5) Form Incomplete/Date Discrepancy(Errors Circled) Form:1/2013 Rel,e[,ont rite 1a3I1efinfttons:'2) Quantity insufficient for analysis(120mL required) 4) Indeterminate Result 6) Other: . . . . . . .. . . ' " •• • • ... • : . . • ..... .. . . . . ...- - •. - • . .. • ::.... . • ‘Tarrot..ppootypithoc•Heoti: Inh...00. DRINKING WATER(PAYCOLIFORM SUBMISSION/REPORT FORM .,/,-0.4...4.-N. maigititioritioomditiboraw "0,0 •, • -c,,,,,i• F.,,..2:.:,:•,-::::•: :;,_....:..:2...„.•,,,..: ...:',.:.-: . ,.;..;,.._,,,:,,,;...4.,...,.y..:-.•:•:,,.1.: •,...,.:.A:T,.....42..i...,i-...., :,,.:: :.,.:i 1..:;,-,... .,', 1 -.... f.,T 2-st_-,; 1 11•1 SoulliMattlitwk;Ipiltek • 0,161Ap-.. • co .S. \,,..17*.f.7.9 .kohittiax-riatu. suelaso.staisti Public • r • w .11Slosi he rag*IWO&AO awe• _ . . ._.., . %4-,,,,....-_:•4 Phil,01n3114.18 Wdilr,-; PINS th• ' '' • -'•' - — ' .'......' 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