Four Seasons 1-LR 911007 (2)WATER BACTERIOLOGY
Form No. G-19 (Rev. 1/91) '£'~ . ~ Bureau of Laboratories
Date and Time Rec'( ~ ~ ~-. .... ~ - - Date
Do no[ ~ ~ve th~ line ~ Please print w~h ~l~lnt ~n
Water System I.D. No. NA~'OF WATER SYSTEM
~INT OF COLLEC~ON ," COUN~
TI-IAI~I I ;171~,1~/I, t21/Idl~ I I I I I II
NA~
RESULTS ~'"1~1~1 Il I~11.'t IIIIIIIIIIIII IIIIII
9TRE~ ADDreSS (P.O. Bo~
TO: I ~*~ ..~ ,. ~ ,~:. ~:~ ~,
' ~ .... '~' : I I TX
I
CITY ZIP CODE
Texas Department Of Health
Date and
Collection MONTH DAY YEAR TIME AM/PM COLLEOTED BY
SAMPLE IS
TYPE OF SYSTEM (Public Systems Only) WATER SOURCE
::";:~P~bllc ....... [~]Omry ........ F=l-Dl~flbutlon' - -[:~ Raw'- '~[l~l~'~ake-- -
[] Individual [] Bottled [] Construction [] Repeal [] Well Well Depth
[] School [] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not ~wlte below)
Water of satisfactory bacJefiological qu..ali, ty must be free from Coliform organisms
Coliform Organlsmg ~"Not Found ~;~/'"'
[] Found
[] Total
[] Fecal
[] Repeat samples required
[] Unsuitable -- See below
Greenville Hunt County Health Dept.
Laboratory
I.D. No. 480].].
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old. Sample not received
within 30 hours of collection
[] Date discrepancy or form incomplete
(See encircled item)
[] Leaked in transit
[] Other
Greenville, Texas
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy (silt/bacterial growth) present,
possibly compromising test results