Callahan-LR030204("~ ~ , ,-~. • ~, ,,ter, "-- ,w~._ ~.~,, _ ...,..~, :-, _.. _ .. .
TARRANT COUNTY PUBLIC HEALTH LABORATORY
WATER BACTERIOLOGY 1800 University Dr., Et. Worth, TX 76107
Lj6 No:48010 181718717245
i
Date and Time ' " '
Date
Recd. Reported
a Nat Mark Above Thia line -----Pleaae Print Below witb"BALLPOINT PEN OR TYPEWRITER:
~Yl~.r;~ ~ / L'~.-tom ~~ ~ ~ ~' ,-x=-. t~.~ ~',ycl~~4~/ a~r~t~,
~~~ ~a ~
NAME OF WATER SYSTEM
~.- ,
i`r +~ C' ~ l w y S t°s'~ r%K C
POINT OF COLLECTIONISAMPLE DESCgIPTIOM Water System I.D. No.
NAME
SEND ~ ~~ A R k lN,~,+~. I~ lVV . O /-:iC r/
~ y~-=
RESULTS STREET ADDRESS (P.O. Box)
A CI1Y Rip
PHONES COUNTY
Dots and 2
Timaof ~ ~ ~ G ~ ~ 0 Q ~ Y 1,, t'~ t~j
Collection Month Day Year TIME AMIPM Collected By
~/ TYPE OF SYSTEM
~jJ Public ^ Dairy
^ Individual ^ Rottk:d
^ School ^ Vended
SAMPLE IS
^ Distribution ^ Raw
[~'Eonstruction ^ Repeat
^ GlycollSweetlChill Water
^ Other
WATER SOURCE
^ River Y Lake
^ Well
Well Uepth
Chlorine Residual a'a
Additional Information:
LABORATORY REPORT IDo no write below) TECH
MMO-MUG
Presence(Absence
Ca{iform Organisms
Not found ~~
^ Found
^ Total Galiform group
^ fscherichia coli
^ Repeat samples required
^ Unsuitable -- See below
Membrane Filtration IMF)
Coliform Organisms
^ Nat found
^ Found
Total Colifarm1100 i
Ecali{ i00 ml
- Fecal Coliforms1100
^ Unsuitable -- See below
MMO•MUG
Most Probable Number (MPNI
Coliform Organisma
^ Not Found
^ Found
Total
Coliform: MPN1100m1
fcoii: MPNIi00m1
^ Unsuitable -- See below
UNSUITABLE FOR ANALYSIS••PLEASE RESUBMIT
^ Sample tea old. Sampk: not received ^ Ouan[ity insufficient tar analysis
within 30 hours of collection (100 ml. required)
^ Date discrepancy ar form incomplete ^ Heavy (siltlbacterial grow[hl present,
ISee encircled iteml possibly compromising test results
^ Leaked in transit
^
Other
^ Quantity too great m permit agitation
^ Excessive chlorine residual:
mglL
_ H•220 GPG2190 Rev. Ot-02