121 BP Phase 1-LR 991111",. ~. ,;-'~- ':',. -.-,- TARRANT COUNTY PUBLIC HEALTH LABORATORY
'V~ATER BACTERJOLOG~ ; 1800 University Or.. ,,. Worth. TX 761,
Lab No. 48010 (817)871-72
Date and Time Re;'.d,. Date
Sample No. '., ~ R~orted
Do Not Mark Above This Line -----Please Print Below witl~ BALLPO iT. PEN OR TYPEWRITER:
NAME OF WATER SYSTEM ./' ~, ~O,~,,~,~#;~\'~'~' J
POINT OF COLLECTIONISAMPLE DESCRIPTION Water System I.D. No.
~;'
' ,E,. ..eh. ) :m- X O
! RESULTS STREET ~DDRESS[P.O. Box}
CITY -- ~ IZip Code)
PHONE# COUNTY
,0,';::;' ITl :
Collection I~lonth Day tear TIME AM/PM Collected By
TYPE OF SYSTEM SAMPLE IS WATER SOURCE
~r?ublic [] Dairy [] Distribution [] Raw [] River [] Lake
'1-'1Individual []Bottled []Construction [--]Repeat l-]Well
[]School l--Wended I-'IGl¥col!SweetlChill Water Well Depth
A-]Other Chlorine Residual
·- Additional Information:
-:. LABORATORY REPORT (Do no write below) TECH
i MMO-MUG. Membrane Filtration (MF) MMO-MUG
PresencelAbsence Most Probable Number (MPN)
' Coliform Organisms Coliform Organisms Coliform Organisms
[] Not Found O ;'~ [] Not Found [] Not Found
[] Found [] Found [] Found
[] Total Coliform group Total Coliform/lO0 mi Total
[] Escherichia cMi E. col~/ l OO ml Coliform: MPN/10Dml
_r-I Repeat samples reLquired , Fecal ColiformsllO_O mi .£.co1~' MPN/10Oml
[~"Onsuitable -- See below [] Unsu~able -- See'below [] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Sample too old. Sample not received [] ~Jantity insufficient for analysis
within 30 hours of collection I100 mi. required)
: [] Date discrepancy er i'orm incomplete [] Heavy (silt;bacterial growth) present.
: (See encircled item) possibly compromising test results
r [] Leaked in transit [] Sample received on Friday
; [] Quantity too great to permit agitation [] Other
- [] Excessive chloride residua~:__.mg/L
~ H-220 GPC-2190 '.~EV. 6-9'
TARRANT COUNTY PUBLIC HEALTH LABORATORY':~.- .:.'".~ ,::r,:,.-c.
1BOO University Dr., Ft. Worth, TX 76107
WATER BACTERIOLOGY Lah No. 48olon 0 V
Date and Time Rec'd. · ~ ~ Date
Sample No. -: . '" Received
-' i '~ .-, Reported
Do Not Mark Above This Line -----Please Print Below with BALLPOINT I~EI~ OR TYPEWRITER:
POINT OF COLLECTIONJSAMPLE DESCRIPTION Water System I.D, No,
NAME
RESULTS STREET ADDRESS (P.O. Box)
TO:
CI~ * /
Collection Monlh Day Year TIME AM/PM Collected By
TYPE OF SYSTEM SAMPLE IS WATER SOURCE
~Public r-]Dairy [--~Distribution F'lRaw [-'l River [--ILake
[--hndividual r']Bottled [--IConstruction [--IRepeat [--IWell
[--ISchool [--IVended [--]Glycol/Sweet;Chill Water Well Depth
r-'lOther Chlorine Residual ',~ · ~
Additional Information:
LABORATORY REPORT {Do no write belowl TECH
MMO-MUG Membrane Filtration (MF) MMO-MUG
PresenceiAbsence Most Probable Number (MPN)
Celiform Organisms Coliform Organi~ns Coliform Organisms
Not Found ~ c ~' [] Not Found [] Not Found
Found [] Found [] Found
[] Total Coliform group Total ColiformllO0 mi Total
[] Escherichia co/i E. co/i/1 O0 mi Coliform: MPN/IOOml
[] Repeat samples required Fecal ColiformsllO0 mi E. co/h MPNIIOOml
[] Unsuitable -- See below [] Unsuitable -- See below [] Unsuitable -. See below
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Sample too old. Sample not received [] Quantityinsufficielt for analysis
within 30 hours of collection {100 mi. required]
[] Date discrepancy or form incomplete [] Heavy (silt~bacterial groenh) present.
{See encircled iteml possibly compromising test results
[] Leaked in transit [] Sample recmved on Friday
[] Quantity too great to perrmt agitation [] Other
[] Excessive chlorine residual: mglL
H-220 GPC-2190 RE;V. 6-97
· ?. ~ .-. .... TARRANT COUNTY PUBLIC HEALTH LABORATORY
· 180D University Dr., Ft. Worth, TX 76107
"WATER BACTERIOLOGY La, No. 480~o
Date and Time Rec'd. , ; ~,: .,,; ~ ' Onto- · .
Sample No. - ' Reported
Do Not Mark Above This Line -----Please Print Below with BALLPOINT PEN OR TYPEWRITER:
NAME OF WATER SYSTE~ ~, -,.~,,~7'~
' POINT OF COLLECTIOMJSAM~E DESCRIPTIO~ Water Sptm I.D. ~o.
~M~
RESULTS STRE~ADDRESS~.O, Bo~
Collection Month Day Ye~ TIME AM/PM Collected By
TYPE OF SYSTEM SAMPLE IS WATER SOURCE
Pnublic ~Dai~ ~Distribution ~Raw ~River ~Lake
dividual ~Bottled ~Constr~tion ~R~eat ~Well
~School ~Vend~ ~ GIycollSweetlChill Water Well D~th
~ Other Chlorine Residual
Additional Information:
LABORATORY REPORT ldo ~o write below) TECH
MMO-MUG Membrane Filtration (MF) MMO-MUG
PresenceJAbsence Most Probable Number (MPN)
Coliform Organisms Coliform Organisms Coliform
~ Not Found ,~ / - ~ Not Found ~ Not Found
~ Found ~ Found ~ Found
~ Total Colifo~ group Total Colifo~llO0 mi Total
~ E~cher~hb coil E. col~lO0 mi Colifo~: MPNIIOOm[
~ Repeat sables r~uir~ ~. Fecal Colifor~llO0 mi ~co/~ MPNJIOOm[
~' Unsuitable -- See below ~ Unsu~ble .- See ~elow ~ Unsuitab~ -- Sm below
UNSUITABLE FOR ANALYSIS.-PLEASE RESUBMIT
~ Sample too old. Sample not received ~ Quantity insufficient for analysis
~thin 30 hours of collection (100 mi. fequi~ed)
~ Date discrepancy Df forminco~iete ~ Heavy Is~t~bacterialgro~h) present.
(See eflci~cled item) possibly co~[omising test results
~ Leakedin transit ~ Sa~ler~eived on Fr~ay
~ Ouantity too 9real to pe~t agitat~n ~ Other
~ Excessive ch~rJfle resi~aJ: m~L