Park West CC(17)-LR 990218 TAJ~RANT COUNTY PUBLIC HEALTH LABORATJ]BY
1800 Univ6 Dr.. Ft.'Worth, TX 76107
VV~P,~FI BAC FERIOLOGY Lob RD. 48010 1817}871-7245
Date and Tkne Re(~l.; 'i :i~' - -~ ! Date
-i
Oe Not Mark Above Thio Line ---Please Print Below with BALLPOINT PEN OR TYPEWRITER:
RAME OF WATER SY~FEM
POINT OF C0LLECTION/SAMPLE DESCRIPTION Water S,t~m i.D. No. Ct)
RESULTS STREET ADDRESS (P.O. BeJQ -- ~ l"
PHONE# COUNTY
CeB~ctien Month Day Year TIME AM/PM CMlasted By
TYPE OF SYSTEM SAMPLE IS WATER SOURCE
~ ~ Pal~lCm:kJal I--]Dairy r'-] Oistributiofl I--1Raw r-I River [--ILake
I--]Bottled r--IConstructien I--Inepeat f--lWell
[--IScheel I~Vended r-IGlycollSweetlChill Water Well Depth
r'tother Chlorine Residual
PrmncdAl~Bnee Melt Probabb Number (MPN)
Celifeml Organisms Coliform Organisms Coliform Organisms
I~ Not Found.~At,,/~/. [] Not Found [] Not Found
[] Total Coliform group Total Coliform/lO0 nd Total
[] E'sc~ co~ E. co/i/100 nd Coliform: MPNIIOOnd
[] Repeat samldeS required Fecal CerdermsllO0 nd E.~. MPNIIOOnd
.... ONSmTABLE FOR A'RALYS,S--PLEASE RESUBMrT
[] Sampletasdd. Sanqdellotrer, eivld [] OlmntJtyinsufflcientfm'anidysis
within 30 hours of cekction ' (100 nd. required)
[] 0ate discrepancy o¢ foe incooqdeto '
Heavy
(satfDicternd
growth)
(See encircled item) pos,tibly ~w,m,ls;.g test results
H-220 GPC-2190 REV. 6-97
WATER
Do Not Mark Abo~ This Uae ---PI.. Print BeI~ W~ B~O~EN OR ~P~ER:
NAME OF WAT~ SY~ :.
RESULTS 8TRE~ AD~E~ ~.0. B~ TO:
~BE ~ COU~
Cdl~ ~h D~ Ym TIME AM/PM bl~d By
~PE OF SYSTEM SAMPLE IS WATER SOURCE
~Ot~ ChM~ R~I
.... .
UBSU~AB~ FOR A~ALYSIS~L~SE RESU~