Gateway BP(1.2)-LR 970123Point of Collectio~ ' Colle(~ted By
CITY OF LEWI~LE LABORATO~ -
Counly
(Uo/Day/Yr)
Reporting STREE~.,~?j¢/
Address:
WATER BACTeriOLOGY
Water System Identification Number
TYPE [] Public
OF
SYSTEM: [] Other.
[] Individual
SAMPLE [] Distribution [] Special
IS:
[] Repeat for sample #
[] Recheck for sample #
[] Olher.
WATER [] River I-'~' Lake
SOURCE:
Well depth
/~] Construction
[] Well
Chlorine Residual
ANALYTICAL METHOD & RESULTS:
~r;s~er;'t~A~sent: Total Co~ Pros. ant
FeCal Coliform Present
M.P.N. Total Coliform
Fecal Coliform
/100ML
/IOOML
Membrane Filter/Fecal Coliform: 1st Dil .... / ~_ mi 2nd / mi
Avg._ /____mi
Unsuitable For Analysis:
[] Form Incomplete (see encircled item)- ~ , ..,.
[] Sample leo old, riel received within 30 hours of collection
[] Excessive chlorine present in sample
[] Unsuitable conlainer
[] Heavy, non coliform bacteria/silt presenl possibly obscuring and compromising tesl results
[] Quantity too great to permit agitation --
[] Quantity insufficient for analys~s (100 mi minmum)
[--]Other AnalyzedbY ~',~, ~,
Water of satisfactoq/ba~erological quality shc~ be free from Coliform Organisms.