Westbury Manor-LR 990329~r ~ T~"qANT COUNTY'~PUBLIC HEALTH LABORATPqY
WATER BAC~T'ERIOLOGY lm Unhmr,~,Or.. Ft. W,~. TX 76107
~ No. ~I0 (817)871-7245
~ Nel Mark Abe~ Th~
! ' NAME OF WATER SYSTEM
POliT OF COLLI~CTIUNiSAMPLE DERCN'IPTIUN
NAME
RESULTS STREET ADDRESS P.O. Bex)
Wmr Bystem I.D. lo.
TO:
CITY
PHUNE if COUNTY
OMI
Cleon Month Day Year TIME
~ TYPE OF SVSTEM SAMPLE IS
r~Pubflc r~lDairy' I--IDistribution r~Raw
[]ln(flvkkJal [~]Bettkd C~Conatructh)n []Repeat.
r~Scheel r-lvended r-16~-c(dlSweetlC~ll Water
[~Other
Add,kraal Infermath)n:
AM/PM
Col~cted By
WATER SOURCE
DL~ce
I-lWdl
wou Dd,
Chlorine Resid.al
MMO-MUG
Prncence/Abncnce
Cdifem Organisms
Nat Found
[] Tatal C(d~orm group
[] Esc/widd~ co/i
[] Repeat .nqdes req~ml
LABORATORY REPORT ~h) no write bah)md
Membrane Filtration {MI:)
Cdifom Orpnbim
[] Not Fo~
[] Found
Total CCdifOnTdl00 nd
£co~'100 mi
Fecal CordormsllO0 nd
UNSUITABLE FOR AIALYSIS-,PLEASE RESUIMrr
[] San~teodd. Sempbnetfece~ed
adth~ 30 heurs of cekctkm
[] Dire chcrepmcy or form klcempkte
(See eockckd hem)
[] Oumtity ?greBt'to pend~BOitltiofl
[] E__,,~___~ve cldorine r.idud: mo/L
TECH
MMO-MUG
Me~t Prebak~e lumber
Cdiferm 0rlanims
[] Not Found
Total
Coliform: MPNIIOOnd
E. cd~J:. MPN/IOOnd
[] Oumdty ksufficknt for afl~/m
(100 nd. requknd)
[] Heavy (dtrlmctldd growth) present.
posddy cempromLmg test resufls
[] Samp~ rece~nd off Friday
[] Other
H-220 GPC-2190
REV. 6-97