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First United-LR 991012WATER BAC~ ~.i~iL(j(;~' Wichita Fails tlcaith I)i,tnct F, ~ WB {Jan 96~ I.aN~ratorv Services Division Date & Time Rcc'd: · · Date PI. EASE Prim Belo~ -ith BAI.LPOINI' Peu or '~'PE~RIIER Wat~ S>stm ID N3r. Name of Water System ~ ' Point of Collection Count' Submitter ID N.: Submitter Phone Street Ad,ess ~ / / City. State. Zip of Collation . Mon~ - Day - Y~ ~imc .~M - PM Collected by: TYPE OF SYSTEM SAMPLE IS ~'ATER ~L~CE ( ~ Special In fo~ation: LABO~TORY REPORT ~ n~ Vat~ of satisthmo~' bacteriologiol quali~' ~ST ~ D~ ~om Colitbm orgasms. C()Li~)~M ORGANISMS: i'~t McthtM: ~e Fo~6:Negative ~'T F~l Colil?ms {E. goli) Unsuitable fi~ .~al~is - PLEASE Rcsu~it Reason: Wichl~ Fall~'ichi~ C~n~ ~blic Health D~t~t ~rato~, CL~ ~5~72374 1700 l~d Sw~t. Wichita Falls. T¢xas 76301-2199 Phone: 817-761-7835 /- F~: 81 ,-.67-__42 TYPE OF SYSTEM SAMPLE IS %'ATER SOURCE /"Public --- Dai,?' __ Distribution __ Raw' __ Ri,er _ Lake P~I Cons~¢lion Special {nfo~ation' LABORATORY REPORT .k'at~ ofsatisfa~oW bacteriolcgica! qualiw ~$T COLIF()ZM ORGM, ISMS: l ~ Fcun~egativc for: Total Colif,)m:s , Fgx:aI Coli[orms (E. Coli) Repeat Sample REQUIRED