Shadydale Lot 2C-CS011003 TARRANT COUNTY PUBLIC HEALTH LABORATORY
1000 University Dr,, Ft, Worth, TX 76107
WATER BACTERIOLOGY bkNo. 48010 (817)871-7246
Date and Tdue Rec'd. Date
Sample No. I ~ . .. . Reported
Do Not Mark Above This Li~e :~-PI~el~e Print Below with BA LLPOINT* P ,~N O ~ ,1~. PEV~ER:
b //
,,~ , / NAME OF WATER sY~rEIdl
,:...,
NAME
R~SULTS STREET ARDRES~ (P.O. Rex)
~HONE ~
and
of
CoO~don Mon~
~PE OF SYSTEM
~Public ~Dai~
~Bott~
~v~
COUNIY
Yea~ TIME
SAMPLE IS
Tx 7Z
AM/PM
Additionat Information:
IZip Code)
f-IDistrilmtion E:]Raw
O~lCmlstruction I~lflepeat
[-I GIycol/SweetJChiil Water
F'10the
Collected By
WATER SOURCE
r'-lRieer r~Lake
Weal Depth
Chlorine Residual
LABORATORY REPORT (Do no write be4ow)
TECH
MM0-MUG
PreeenceiAbsence
Coliform Orglflisms
I~ Not Found :~,,/,.
[] Found
[] Total Coliform greep
[] E~cherichb co/i
[] Repeat seeTples required
[] Unsuitable .. See babw
Membrane Filtration (MR
Coliform Organisms
[] Not Found
[] Found
Total Cofiforr~lO0 mi
£ co///100 nd
Fecal ColiformsllO0 mi
[] Unsuitable .- See below
MMO-MUG
Moat Probable Number (MPN)
Coliform Organilm~
[] Nat Fmmd
[] Found
Total
Coliform: MPNIIOOml
E, co/~' MPN/IOOnd
[] Unsuitable -. See below
UNsUrrABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Qumple too old. Sample not received
within 30 ho~s of collection
[] Qute discrepancy or form incomplete
(See encircled item)
[] Leaked in transit
[] Quantity tdo g~eat to pmmit agiTatiofl
[] Excessive chlorine residual: moll
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy {silt~bacteriel growth) premat,
possibly compremising test result=
[] Sample received off F~day
[] Other
H-220 GPC-2I~O REV. 6-97