Park West CC(6)-LR 980601 WATER BACTERIOLJ3~Y Texas Department of Health
Form No. G-19 (Rev. ') Bur~'-"of Laboratories
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. t:~O :~1~ ..a~,,above this line-- ~'"'" ..... ~rjy ', ..~.
Please pri~'ii~lll,l,l~pointpen,,q p~.writ~
Water &ystem I.D. No. J NAME OF WATER SYSTEM
POINT OF COllECTION COUNTY
SubmitterI.D. No. J J J i J J
NAME
STREET ADDRESS (P.O. Bo~t)
CITY --~ ZIP CODE
Collection ~ I III fLL J
MONTH DAY YEAR TIME AM/PM -- COLLECTED BY
SAMPLE IS
TYPE OF SYSTEM (Pub#c Systems Only) WATER SOURCE
[] Public [] Dairy [] Distribution [] Raw [] River ~
[] Individual [] Bottle~t.. ~ns~on [] Repeat [] Well Well Depth
[] School [] Special Chlorine Residual
,. Ownership or other information:
LABORATORY REPORT (Do not write below)
*-}Nater of satisfactoryt~__a?teriological quality must be free from Coliform organisms
Coliform Organisms ~ Not Found ~
[] Found ~'~
[] TotaJ coliform group ~
[] Escherichia coil :
[] Repeat samples r~uired
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old. Sample not received [] Quantity insufficient for analysis
within 30 houm of collection (100 mi. required)
[] Date discrepancy or form incomplete [] Heavy (silt/bacterial growth) present,
(See encircled item) possibly compromising test results
[] Leaked in transit
[] Other
WATER BACTERIOL, QGY Texas Department of Health
Form No. G-19 (Rev, ) Bu[~",of Laboratories
[% ." I~z ~t ~ above this line- Please prin~With ballpoint pen olk~typewriter.
Water 3y~tem LD. No. J NAME .~tr--IWATER SYSTEM
SubmitterlD No..II I I I I ] I
NAME ! ..
RESUL'I~ Lz '
To: 6TREET ADDRE$8 (P.O.
CITY/r ZIP CODE
CollectionTime°f L~'I ~J'~J I,,I
MONTH DAY YEAR TIM~ AM/PM ~CTEO BY
TYPE OF SYSTEM-' SAMPLE IS "
(Public Systems Only) WATER SOURCE
[] Public [] Dairy [] Distr~ution [] Raw [] River [~ke
[] Individual [] Bottled [~"onstruction [] Repeat [] Well Well Depth
[] School [] Special Chlorine Residual
Ownership or ether information:
LAaORATOm' aF_eOm'i(oo n-~ .rae ~low)
wate_r.o! sa'~sfactory bacteriological quality must be free from Coliform organisms
C~llform Orglmism$ ~ Not Found~
[] Total colifmm group
[] Esch~chia ¢oli
[] ~at samples--r.~uired
UNSUITABLE FOR ANALYSIS - PLEASE RESuBMiT
[] Sample too old. Sample not received [] Quantily insufficient for analysis
within 30 hours of collection (100 mi. required)
[] Date discrepancy or form incomplete [] Heavy (silt/bacterial growth) present,
(See encircled item) possibly compromising test results
[] Leaked in transit
[] Other
WATER BACTERIOL.~Y Texas Department of Health
Form No. G-1_9 (Rev.--) Burr~'~-fl Laboratories
Date and Time Rec'd. ',: Date
Sample No. Reported
~ O~ r~ ~e~k~eove this
[-'..', line -- Please print_w_lth ballpoint pen or typewriter.
' ~ i II ";t - t-~" """' '
Water System I.D. No. NAM~ ~F WATER SYSTEM
POINT OF COLLPCTION COUNTY -
Subrni~er LD. No.
STREET ADDRESS (P.O. Bo~
Collection - -
MONTH DAY YEAR TIME AM/PM COLLECTED BY
TYPE OF SYSTEM- SAMPLE IS
(Pul~ic Systems Only) WATER SOURCE
[] Public [] Dairy [] Distribution [] Raw [] River I~'L'~e
[] Individual [] Bottled [:]~3nstruction [] Repeat [] Well Well Depth
[] School [] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below)
Water of satisfactory bacteriological quality must be free from Coliform organisms
Coliform Organisms ~ Not Found
[] Found ~
[] Total coliform group
[] Escherichia colt
[] Repeat samples required
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old. Sample not received [] Quantity insufficient for analysis
within 30 hours of collection (100 mi. required)
[] Date discrepancy or form incomplete [] Heavy (silt/bacterial growth) present,
(See encircled item) possibly compromising test results
[] Leaked in transit
[] Other