Northlake 635(4)-LR010109 (4)WATER BACTERIOLOGY tsoo U,ivnrsity Or., Ft. Wa,tb, Tx 76107
Lab No. 4B010 (817)871-7245
Date and Time
Sample No.
SEND
RESULTS
TO:
Do Not Mark Above This Line *----Please Print Below with BALLPOINT PEN OR TYPEWRITER:
:.
- ! / NAME OF WATER SYSTEM
POINT OF COLLECTIONISAMPLE DESCRIPTION
NAME
/,,?'o ? :72
STREET ADDRESS (P.O. Box)
CITY IZ~ Code)
co,,,,
Collectien Month Day Year TIME AMIPM Collected By
Water System I.D. No.
TYPE OF SYSTEM SAMPLE IS WATER SO, URCE
[] Public [] Dairy [] Distribution [] Raw [] River [] Lake
r-]individual []Bottled '"~ Construction []Repeat []Weft
[]School •Vended [-IGIycolISweet/Chill Water Well Depth
[-]Other
Additional Information:
LABORATORY REPORT ldo no write below} TECH
MMO-MU6
Presence/Absence
C~.Nrm Organisms
ot Found
[] Found
[] Total Coliform group
[] Repeat samples required
[] Unsuitable -- See below
Membrane Filtration (MF)
Coliform Organisms
[] Not Found
[] Found
Total Coliform/lO0 mi
£.co/i/ l O0 mi
Fecal ColiformsllO0 mi
[] Unsuitable -- See below
MMO-MUG
Most Probable Number (MPN)
Coliform Organisms
[] Not Found
[] Found
Total
Coliform: MPN/IOOml
E. col~' MPNIIOOml
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS--PLEASE RESUBMIT
[] Sample too old. Sample not received
within 30 hours of collection
[] Date discrepancy or farm incomplete
(See encircled item)
[] Leaked in transit
[] Quantity too great to permit agitation
[] Excessive chlorine residual: mg/L
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy [sift/bacterial growth) present,
possibly compromising test results
[] Sample received on Friday
[] Other
H-220 GPC-2190 REV. 6-97