Mobil Sta MacA-LR 890623 WATER BACTERIOLOGY Texas Department of Health
Form NO. G-lg (rev. 10-84) ~ure~u o! L~,bo~atorles ,~..
Date and Time Rec'd '~'- Date :~.:. - '
Sample No. ., -~- : Reported ...~..
Do not mark above this line -- Please I~lnt with bl.I.. Iboin! I~ or typewriter
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NAME OI~"~rATER SYSTEM ---- COUNTY " !. _
SEND RESULTS TO:
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Water SystemldentificaiionNumber ~LI I III I1~~'~~ ::.'.._. .
_~ublic ~ Dairy ~ Distribution ~ Raw ~ River ~e ..... ..
~ ~nstruction ~ Check ~ Well .Well~pth~ ~ '
~ Individual ~ Bottled ; -
' -- ~Sp ..~ ~' "
School Chlorine Residual __ :
Ownership or other information: /~ ' :'.-
Water of satisfactory ~CtO~~8~~~,Or~ orOa~,8~,
MF Coliform Count (verified) -/lOOml.
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
~ Sample too old. Sample not receiveO ~ Only one sample per time and point of collection
within 30 hours of collection required
~ Date ~iscrepancy or form incomplete ~ Hea~ {silt/bacterial growth) (with colifo~ms) present,
(See encircled item~ ~ssibly obscudn~ ~nd co~p~om{s{~g test
~ Quantity insufficient for analysis
~1~ ~, ~i~imum) ~ Quantity t~ great to permit agitation
~' Leaked in transit ,~ Other
_ Not an approved container '