Northlake 635(5)-LR000216 STREET <~4//d
Address~
TELEPHONE( )/---~ ~rl' ~'~ (Zip Code)
Water System Identification Number
SYSTEM: [] Other.
SAMPLE [] Dislribution [] Special ruction
[] ReCheck for sample,
WATER [] River Well ,-~
~Well depth Chlorine Res dua[~,
ANALYTICAL METHOD & RESULTS: -? - ~
.~PreSent/AbSent: Total Coliform~'"~ Present :' ¢.,]
M.P.N. Total Coliform .~ /lOOML
(Colilert) E. Coll.
Membrane Filter/Fecal Coliform: 1st Dil. / mi 2nd ____/ mi
Avg. /_
Unsuital~o For Analysis: .'7;',
[] Form Incomplae (see encimled item) T' '
[] S~, not received within 30 houm of c(~lecfion
[] Excessive chlorine present in san~ple
[] Unsuitable conlaJner
[] Heaw, non coliform bacleriaJsilt present, possib~ obscuring and compromising test
[] Quantity IOO I;Feat Io permit agitation
[] Quanlity insufficient for analysis (100 mi minmu~
Wat~ of sati~facto~/ba~erolagical quality should be free from C.,o~4form Organisms,
CITY OF LEWISVILLE LABORAT ,O~RY - WATER BACTERIOL(N3Y ·
'p-o~ Collected By Datp. Ti ~J
(Uo/Day/Yr)
Address: STREET :
TELEPHONE( )Z-,./~.'/' -Z~ ~' ~' (ZiP Code)
Water System Identification Number
SYSTEM: [] Other r-~ -
IS: [] Repeat for sample # ~':-; ~ ~ ""
[] Recheck for sample # ,
~I [] Other.
WATER [] River ~ [] Well ·
SOURCE: Well depth Chlorine ~Residual
ANALYTICAL METHOD & RESULTS:
(Colilert) E:Coli. Present - -
Membrane Filter/Fecal Coliform: 1st Dit. / -. mi 2nd / mi
Avg. _/
Unsuitable For A~lysis: ~ ~
~ Fo~ In~mpl~e (~ encirc~d ffem) ~ - ,
~ Ex~ve chlo~ne print in ~ple
~ Unsu~ ~nt~ner
~ Heaw, non ~li~ ba~en~ll pre~nt, po~ibN o~u~ng and compromi~ng tea re~lt~
~ Qu~ t~ g~t to ~rm~ afftation '
CITY OF LEWISVILLE LABORATORY - WATER BA~TERIOL
Name of Waler System Counly
Point of Collection Collected By D~ie' -'~
(Mo/Day/Yr)
Reporting
Addr~s: STREET
CITY ~0~
TELEPHONE(,__,)
Water System Identificalion Number
TYPE [~ub~ic '~ Individual
OF
SYSTEM: [] Other
SAMPLE
[] Distribution [] Specia~ I~ruction
iS:
[] Repeat for sample #
[] Recheck for sample # ,,~.,,~
[] Other '
WATER
[] River [~"L~ake [] Well
SOURCE:
Well depth Chlorine REsidual
ANALYTICAL METHOD & RESULTS:
Coliform"~ Present
Absent
Total
(Col'ilert) E :C01i. Present
M.P.N. Total Coliform /100ML
/100ML
(Colilert) E. Coll.
Membrane FiltedFecal Coliform: 1st Dil.__/_ 'm_J 2nd /__mt
Avg /
Unsuitable For Analysis:
[] Form Incomplete (see encircled item)
[] Sample IOO old, not received wilhin 30 hours of colleclion
[] Excessive chlodne present in sample
[] Unsuitable container
[] Heavy, non coliform bacteria/silt presenl, possibly obscuring and compromising tesl results
[] Quantity too great to permit agitation
[][] Quantity insufficient for analysis (100 mi minmun~) ~ Other
Analyzed by ·
Water of satisfactory ba~erological qual~'y should be fr~fr~m Coliform Organisms,
I Iii i II