St Andrews Manor-LR020415WATER BACTERIOLOGY
DENTON MUNICIPAL LABORATORY
1100 Mayhill Road, Denton, TX 76208
LAB #48130
Date & Time Rec'd
Sample No.
OD not mark above this line -- Please print with ballpoint pen or typewriter.
Name of WatedSystero
Water System I.D. No,
~ Coun~
Send Name~
/.o. lqq
Results
Street Address or P. O. Box
.TX 7 'o3
Zip Cede
O -a II'00
Collection __ / / .
Month Day Year Time AM PM
TYPE OF SYSTEM
Public Bo~led
Individual __ SchoOl
SAMPLE IS
(Public Systems Only)
nstruction
__ Special .
Raw
Repeat
~,.//R Chlorine Residual
Collected By
WATER SOURCE
River __ Lake
Well
Well Depth
L~BORATORY REPORT (Do not write below)
~..~,~~l~~a, qualily must be free from Coliform organisms.
//' Total Colilorm group
~- Escherichia coil
L/ Colilert
Unsuitable - See Below
__ Repeat Samples required
Repeat Samples suggested
MF/TC -- MPN MFZFC __ HPC
Unsuitable ldr analysis - Please re~ubmd ,
Sarape too old. Sample notlreceived in time to analyze within 30 ~'urs of colleclion.
. Date discrepancy or Io.~m incJ3m~let/~'(~-e'e~ encinjled ilem~ (. (~/~:/
per 1 n~
per tO0 mi