Creekview P2 L1R BA-LR021031ICl'FY OF LEWISVILLE LABORATORY. WATER BACTERIOLOGY
'~Point Of Col{ecti6n
Billing/
I~epoding
Addr~:
County
~C~y Date Time
(Mo/Day/Yr)
STREET ~-)~' ~ )~r~//
c~Y ~, ~ ~Y/, ~x~s
TELEPHONE(~ ~ ) ~ - ~/ (~)
Water System Identification Number
TYPE [~ub~c
OF
SYSTEM: f-1 other
[] Individual
SAMPLE [] Distribution [] Special
IS:
[-'1 Repeat for sample #
[] Recheck for sample #
[] other
~-Censtruction
WATER
[] R~'er ~Lake
SOURCE:
Well depth
[] Well
Chlorine Residual
ANALYTICAL METHOD & RESULTS:
_ P~nt/Absent: Total Coliform~ Present
(Colilert) E:Coli. Present
M.P.N. Total Coliform
(Colilert) E. CoIL
Membrane Filter/Fecal Colifoffn: 1st Dil. /
Absent
__./IOOML
__./IOOML
mi 2nd __./.__mi
Avg. /____mi
Unsuitable For Analysis: r'~.o
[] Form Incomplele (see encim'led ilem) t,.J'
[] Sample 1oo o~d, nm received wilhin 30 hours ol oo~lecti°n r~
[] Ex~,~ve chlodne ~eeenl in sample
[] Unsuitable conlaine~
E] Heavy, non colifoml bac~e~i/sill presenl, possibly obscurklg and compromising test res~Jlts
[] Quantity too groat ~o poma agi~m A
[] Quantity insufficient for a~alysis (100 rnl minmum) ~ ,,AJ~vv
Analyzed by