SC-Cottonwood E9-LR 960807WATER BACTERIOLOGY •� , 1 Texas Department of Health
Form No. G -19 (Rev. 2193) Bureau of Laboratories
Date and Time Rec'd. ' - - Date
r r�-• - r,, �, Reported
Do not ma abc*wthlis line — Please print with ballpoint pen or typewriter.
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Water System I.D. No.
NAME OF W
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POINT OF COLLECTION COUNTY
Submitter I.D. No.
SEND rIIITY.rI IQ J IttINF,1 11 i i 6Inlna4lhl 10AlAlA I)I/1
NAME J n �
RESULTS b'I, 151 tl A It IkIIJ tit Ibll IYlr�l IQI01 I�Lhd 14PI1$I I I
STREET ADDRESS (P.O. Boil
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CITY I I ZIP CODE
Date and 6A �.� m
Time of
Collection MONTH DAY YEAR _ TIME A M COLLECTED BY
TYPE OF SYSTEM SAMPLE IS WATER SOURCE
(Public Systems Only)
❑ Public ❑ Dairy ❑ Distribution ❑ Raw []River ❑ Lake
❑ Individual ❑ Bottled _Otonstruction ❑ Repeat ❑ Well Well Depth
❑ School {] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below)
Water of satisfactory b cteriological quality must be free from Coliform organisms
Coliform Organisms Not Found
Found +
�� ❑ Total coliform group
Y ❑ Escherichia toff
❑ Repeat samples required
❑ Unsuitable �,$esbelow
UNSUITABLE FOR ANALYSIS – PLEASE RESUBMIT
❑ Sample too old. Sample not received
within 30 hours of collection
❑ Date discrepancy or form incomplete
(See encircled item)
❑ Quantity insufficient for analysis
(100 ml. required)
❑ Heavy (silt/bacterial growth) present,
possibly compromising test results
❑ Leaked in transit
❑ Other