CF-Justice Center-LR 961120 ~ ~,~'~'~ l~l~OUniversityDr.,Ft:.~forth. TX76107
WATER BACTER~G ~.~. ~}'[~
48010
(817)871;7245
Date '.
Reported
;,
Do Not Mark Above This Line -.---Pleose Print Below with
NAME OF WATER SYSTEM I ,~,~:?~.~. · ::::,~: .... ,
,[OINTOFCOLL~TION '/ NOV ~ 5 1A~torsy"mlD No
fi ', ~", . - ,-t uuu , "
RESULTS STREET ADDRES~ (P.O. Box)
...... / ,~, ;," ~';; / _ (Z~ Code)
-"-~. PHO~ COUN~
Date ~n~
TimeD,'[- i;,i.F l: ,l I;T 1
Colhctio~ M~th Day Year TIME AM/PM Coll~ad
~YPE OF SYSTEM SAMPLE IS WATER SOURCE
~ublic ~Dairy ~Distribution ~Raw ~River ~'~e
~lndividual ~ Bot~.~d ~Construction ~Repeat ~Well
~School ~Vend~ ~ GlycollSweet/Chill Water Well D~th
~ Other Chlorine Resi~al
Addit~nal Inform~
~. LABORATORY REPORT (Do no write belowI TECH
MMO-MUG Membrane Filtration (MF) MMO-MU6
Pres~cetAbsence Most Prebabfe Numar [MPN)
INform O~anisms Coljfprm Organisms Colifo~ Orgamsms
Not Found ~'-Not Found
Found ~ Found ~ Found
~ Total Coliform group' Total Coliform/lO0 mi Total
~ Eschefichia co~~ E. co///lO0 mi Coliform: MPN/IOOml
~ Repeat samples re, ired Fecal Coliforms/lO0 mi E. co//- MPNIIOOml
~ Unsuitable -- See below ~ Unsuitable *- See below ~ Unsuitable S~ below
..~
UNS~E FOR ANALYSIS-PLEASE RESUBMIT
within 30 hours of collation (100 mi. required) . '~N
~ OQt~ ~scre~ncy or form incomplete.
~ Leaked in transit ~ Sarape received off Friday
~ Quantity too great to ~rmit agitation ~ Oth~
~ Excessive chlorine residual: ..... ~mg/L