Gateway BP(1.3)-LR 990405(~iTY O~: LEWISVILLE LABORATORy. WATER BAC'~F~IOLO~. Y
' N~rne of Water ~y~em '"
Point of Co~locfion
Billin~ ~ NAME
Repodin~ STREI ~ ~
Address:
Colle~te~ By Date Time
(Mo/DaylYr)
TELI~PHONE
TEXAs
Water System Identification Number
TYPE lic ';* [] Individual
OF
SYSTEM: U Other ~
.
SAMPLE [] Distribution [] Special ~;Construction
IS:
[] R~peat for sample #
[] Recheck for sample #
[] Other
WATER [] River E~L/"ake [] Well
SOURCE: Well depth/k. Chlorine Residual
ANALYTICAL METHOD & RES0L'I:~,:
(CoJ!lert~ , E. Coli.
Membrane Filter/Fecal Coliform: ls1 Dil.
Avg.
Present' ~ ~
Present
/100ML
/IOOML
% ~. mi 2nd /__
', i
! mi ~.
mi
Unsuitable For Analysis: ~
[] Form Incomplele (see ~[~.~d item)
[] Sample too 01(~, nol%ecei~.ed within 30 hours of collection
[] Excessive chlorinate, present in sample .
' [] Unsuitable con~aJll~.'~: ::.
[] Heavy, non co~'~ ba~eri~sitt present, possibly obscuring and compromising lest results
[] Quantity too great lo permit agitation ~
[] Quantity insufficien! for analysis (100 rnl minmum)
Analyzed by'~.-.~[ - '~'~ i:
WMer o! satistactory baclerological quality $¢~uld be lree fl'~m Coliform Organisms.