Coppell Industrial-LR010509 (3) TARRANT COUNTY PUBLIC HEALTH [,ABORATORY ·
1800 University Dr., Ft. Worth, TX 76107
WATER BACTERIOLOGY L.,No. 4a,~O (817)871-7245 :'~
Date and Ttme Rec'd. j /~ Date
Do Not Mark Above This Line ---Please Print Below with/BA~LL~OIIT.PEa'OR~PEmlfER~
r (NAME OF WATER SYSTEM '
SEND
RESULTS
TO:
D~and
Time of
POINT OF COLLECTION/SAMPLE DESCRIPTION
NAME
Water System I.D. Ne.
,f/
PHONE # COUNTY
I,,1 '11°1 11,.,I,I I I/l:lAd 1/' 1 ' '
Collection Month Day ' Year TIME
[~.:E OF SYSTEM . SAMPLE IS
•Dairy []~l~r~oution r-lRaw
[] Individual [] Bottled [] Construction [] Repeat
[]School []Vended r'J GlycollSweatlChill Water
r-]other
Additional Information: ,A/~---
MMO-MUG
Presence/Abaence
Coliferln Organisms
~ Net Found
[] Found
[] Total Celiform greup
[] Es~hb co/i
[] Repeat samples required
[] Unsuitable .. See below
AM/PM
Collected By
WATER SOURCE
[]River •Lake
[]Well
Well Depth
Chlorine Residual
LABORATORY REPORT ldo no write below)
Membrane Filtration (MF)
Coliform Organisms
[] Not Found
Total Coliform/lOO nd
E. co///100 nd
Fecal ColiformsllO0 mi
TECH
[] Unsuitable .- S~ below
MMO-MUG
Most Probable Number (MPN)
Coliform Organisms
[] Not Found
[] Feund
Total
Coliform: MPNI100ml
£ce/~* MPNIIOOml
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Sample too old. Sample not received [] Ouandty insufficient fo~ analysis
within 30 hours of collection (100 mi. required}
[] Data discrepancy or form incomplete [] Heavy (sa~actedal growth) present,
(See oncirclnd item) possibly compromising test results
[] Leaked in transit [] Sem01e received on Friday
[] Coantity too great to permit agitation [] Other
[] Excessive chlmine residual: mg/L
H-220 GPC-2190