YMCS-LR020221CITY OF LEWISVILLE LABORATORY - WATER BAC'I~d~IIOLOGY
Counly
Data Time
(Mo/Day/Yr)
TELEP~mONEt'31'~[/ )."~'~ y~l~.-~ (ZipCede)
Water System Identification Number
TYPE ~"~ubtic
OF
SYSTEM: [] Other
[] Individual -
SAMPLE [] Distribution [] Special [~"onstruction
IS:
[] Repeat for sample it
r'-71:-] Recheck for sample it
/.Z [] O, har
~OURCE:
~,~ Well depth Ch~rine Res~ual
.,'~A . c~r)~& RESULTS:
'~~'n~'-~t~l '~,c ~' Presenl
Present/Absent: Total Coliform__...y
(Colilert) E~ Present
MP.N Total Coliform
(Colilerl) E. CoIL
Membrane Filter/Fecal Colifon'n: 1st DiL /.__
Absent
/100ML
/100ML
mi 2nd /.__mi
Avg. / mi
Unsuitable For Analysis:
[] Form Incom~e (see encircled item)
[] Sample too oki, not received within 30 hours of collection
[] ExooSSWe chlorine present in sample
[] Unsuitable contaJne~
[] Heavy. non oolifon'n bacteria/silt present, possibly obscuring and compromising lest results
[] Quantity too gmat to permit agitation
[] Quar.~ i.s.m,:~t fo~ ana~,~ (t O0 r,~ ~n,~m)
[] O~hor ~ . ~J '
^natyzed by