Mansions Phase 1-LR 980730 TA-QRANT COUNTY PUBLIC HEALTH LABORAT-IZRY
; '=' 1800 Unive Or., Ft. Worth, TX 76107
WATET:I-B~ L;T E RI O LO G Y Lab N0.480~0 1~-~4.~
Date and Time Rec'd. ': Date
Sample No. / - ;- ! ~ Reported
De Not Mark Above This Line -----Please Print Iietew Wi~ J~ALLPOINT PER 8R TYPEWRITER:
NAME OF'WJ~;I'ER SYSTEM -"
POINT OF CI~LLECTIONJSAMPLE DESCRIPTION' Water System I.O. No.
4. i! j- .'./ i .,,, ,,, '"~
NAME
SEND · ,, -"~ '
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RESULTS STREET ADDRESS IP.O. Box)
TO:
., .'-'~- ~ TX
CI~: ~ (Zip Code)
PHOBE ~ COUNTY
Collec6o, Month Day Year TIME AM/PM Coll~ted By
~YPE OF SYSTEM SAMPLE IS WATER SOURCE
..~Public ~Dairy D Distribution ~Raw ~River DLake
~lndMdual ~Bottled ~Construction ~Repeat ~Well
~School ~Vended ~ Glycol/SweetlChill Water Well Depth
~ Other Chlorine Residual
Additional Info,talon:
LABORATORY REPORT (Do no write below) . TECH
MMO-MUG Membrane Filtration (MF} MMO-MUG
PresencelAbsence Most Probable Number (MPN}
Coliform Organisms Coliform Organisms Coliform Organisms
/~ot Found .~ [] Not Found [] Not Found
ound ' [] Found ? [] Found
[] Total Coliform group Total Coliform/lO0 mi Total
[] E.~c,~erichia col~ E. col// lO0 nd Coliform:. MpN/IOOml
[] Repeat samples required ~Fecal Coliforms/lO0 mi E. coli: MPN/IOOml
[] Unsuitable -- See, below [] Unsuitable See below [] Unsuitable -r See below
UN~UITARLE FOR ANALYSIS-PLEASE RESURMff
[] Sample too old. Sample not received [] Ouantity insufficient for analysis
within 30 hours of collection (100 mi. required)
[] Date discrepancy or form incomplete [] Heavy (silt/bacterial gruwth) present,
(See encircled item) po,[sibly compromising test results
[] Leaked in transit [] S'ample received on Friday
[] Quantity too great to per~t agitation [] Other
[] Excessive chlorine residual: mglL
!t-220 GPC-2190 REV.