Riverside Church-LR010723 (2) .IkRRANT COUNTY PUBLIC HEALTH LABOR.4iN&RY
1800 University Dr., Ft. Worth, TX 76107
WATER BACTERIOLOGY Lob No. 48010 (8171871-7245
Date and TimeR~ . . ~ . Date
' POINT OF Chi," -..,.I~LE DESCRIJ~JPi~ Water System I.D. No.
RESULTS STREET ADDRESS (P.O. Box}
TO'
CI * IZ~ C~e)
COU~
Collation Month Day Year TIME AM/PM Collec~d By
~PE OF SYSTEM SAMPLE IS WATER SOURCE
~Public ~Dai~ ~ Distribution ~Raw ~R~er ~Lake
~l~ividual ~ Bottled ~ Construction ~ Repeat ~Well
~School ~V~d~ ~ GlycollSweetlChill Water Well Depth
~Ot~r Chlorine Residual
Additional Information: ~0 ~ :~ ~ ~ ~ ~ ,' ~ , ~, c ~t
LABORATORY REPORT (Do no write below) TECH
MMO-MUG Membrane Filtration (MF) MMO-MUG
PresencelAbsence Most Probable Number (MPN)
Coliform Organisms . ~ Coliform Organisms Coliform Organisms
[~ Not Found ~ [] Not Found [] Not Found
[] Found -- [] Found [] Found
[] Total Coliform group Total ColiforndlO0 mi Total
[] E$chedchia co/i £,c~///100 mi Coliform: MPN/IOOml
[] Repeat samples required Fecal ColiformsllO0 mi £.co//? MPN/IOOml
[] Unsuitable -- See below [] Unsuitable -- See below [] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS--PLEASE RESUBMIT
[] Sample too old. Sample not received [] Ouantity 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 [] Sample received on Friday
[] Ouantity too great to pmmit agitation [] Other
[] Excessive chlorine residual: mg/L
H-220 GI~C-2190 REV. 6-97