Verizon-LR 981118Billing/
Reporting
Address:
Water System ~_ion Npmber
I-] Individual
TYPE [:~i=ub#c
OF
SYSTEM: 1-1 Other
SAMPLE [] Distribution [] Special [~lT~strgctlon
[] Repeal for sample #
[] Recheck for sample #.
[] Olher · ,.,
WATER [] River [] Lake [] Well
SOURCE:
Well dep~ll- Chlorine Residual
ANALYTICAL METHOD & RESULTS:
~r~ent/A~3sent: Total Corlforrr~ Present
~"~'~r'O I= :UOI/. Present ~
M.P.N. Total Coliform /100ML
(Colilert) E. Coll. /100ML
Membrane Filter/Fecal Coliform: 1st Dil. / mi 2nd ___/
_i
mi
Avg. /. __mi
SIS':' - -~ ~
Unsuitable For Analy w
I-] Form Inooml~le (me encircled ilem)
['-I Sarnpb too old, not received within 30 hours of
[] Unsuilablo cor~ainer
[] Heavy, non oolikm~ becleria/silt present, possibl~ obscuring and compromiaing test results
[] Quar~ay too g.~ to pema agitation
[] Quantity inm.,lflctenl for analysis (100 nt rnlnmu
[] o~her
CITY OF LEWISVILLE LABORAT ~C?Y - WATER BACTERIOLOGY
.~,~ County
Collected By ' Time , ' ~,(Mo/Da:'~..r)
Reporting '
Address: STREET tll ~_"1 ..~d~,"~,'; f';~'.~Jc
TEXAs
TELEPHONE{ ~'TZ 1 ,,~(~ :~ o5~.s'5~ (zipcode) -
.Waler ~/stem IdenttRcatioo Number --.,.. ,
~,~,.,~, - ~, ,
SYSTEM:,,, ,-
[] Oislr~ution [:~pocial ~struction
I$:
I-"1 Repeal for sample #
.,[] Recheck for sample # '
[] Other.
WATER <
SOURCE: [] RIv~' ['-I Lake [] Well
Well depth Chlorine'Reeldual
ANALY'I'ICAL METHOD &'RESULTS:
~Presant/Absent: Total Coliform,,./ ,
(Coh~ert) ' ~E:~ - ~~/I~)ML ~
M.RN. -'l'~oliform
(Cotilert) E. Coll. ,; /IOOML
MembraneFitterlFe<:atCollform: lstDil./ ~ 2rml , /
mi
Avg. / ~1{ . -~
Unsuitable For Analysis: ' - *~'
[] Form IncOmldele (see e~circied ilem)
J"-] San'q:)le too oki. not received within 3O hours of ~
O'~at~ too ~sat to penra ag. af~
[] Quantity insufficient for analysis (100 mi minmumj
[] other