Town Center L4B1-LR011109 -- ' ' County
(Mo/Day, r)
Waler System Identifi~tion Number ~
~PE ~
OF ~dual
SYSTEM:
SAMPLE [] Distribution [] Special [~Construclion
[] Repeat for sample #
[] Recheck for sample #
[] Other_~ /
'7
WATER
[] River [~Lake [] Well
SOURCE:
Well depth Chlorine Residual
RESULTS:
Present
Present
M.P.N. Total Coliform
(Colilert) E. Coli.
Membrane Filter/Fecal Coliform: 1st Dil. /,
Absent
__/IOOML
/IOOML
· mi 2nde/. mi
Avg.,. /____mi
Unsuitable For Analysis:
[] Form Incomplete (see encimled ilem)
[] Sample too old, not received within 30 hours of collection
[] Excessive chlorine present in sample
[] Unsuilable container .~..>~"5" p,l~,~,'~.~-y' ~-~'0,
[] Heavy, non ooliform bacteda/s~lt present, possibly obscuring and com~ro"rr(rs~l(~ l/e~results
[] Quanlity too greal lo permil agitation
[] Quantity insufficient for analys~s (100
[] Olher~ ~vj~v) ' Analyzed by
W&i~ o! satisfaclory baC. e, rolo,gical quatiby should be free fro,rn cormform Organism~.