Gateway BP(1.3)-LR 990405 (3)CITY OF LEWISVILLE
LABORAT(3~Y WATER BA IOL Y
Billing/
Reporting
Address:
Date Time
~.-----._. ~ (Mo/Day/Yr)
NAME 'J"'~'~ ~ (? ~;~ i i !'t {_-~
CITY, % , ~ ~,,~ TEXAS ~,
Water System Identification Number
TYPE~
[~Sublic ~_[--~ ndividual
OF
SAMPLE "'~ Distribution [] Special
IS:
[] Repeat lor sample #
[] Recheck for sample #
[] Other
WATER [] River ~ [] Well
SOURCE:
Well deplh Chlorine Residual
ANALYTICAL METHOD & RESULTS:
' ... Present
M.P.N. Total Coliform
(Colilert) E. Coil.
Membrane;Filter/Fecal Coliform: 1st Dil.__./ _
Absent
'/100ML
/100ML
mi 2nd ____/
~: Avg / mi
Unsuitable For Analysis:
[] Form Incomplete (see encimled item)
[] Sample too old, ,nol received within 30 hours of~oll~ction
[] Excessive chlodne present in sample
[] Unsuitable container
[] Heavy, non coliform bacteria/sill present, possibly obscuring and compromising test results.
[] Quantity too greal Io permit agitation
[] Quantity insufficient for analysis (100 mi minmum)
[] Other
Analyzed by '~:~' ·
Water o! satisfactory b~erological quality sh,~d be free fr~ Coliform Organis~.
I~ame of'Wat~r]System
Point of Collection CoJJected By