PA9901-LR040517City of Lewisville Laboratory
Water Bacteriology
Water System Identification Number:
Point of Col,~ction Collected By
~, County"
Date ~' ' ',~F~' PM
Bilhng NAME
Repo~ng~.~$TREET
Address
TYPE OF
SYSTEM:
SAMPLE
IS:
TELEPHONE
Zio Code)
[] Public ~..,~wd u ~
[] Dmstnbutlon [] S~oal [~Const~ction
[] Reeeat for samDle ~-
[] Recheck for samele#
[] Other
~'~'a ke [] Well
Chlorine Resid'u,~
WATER r-IRiver
SOURCE:
~.! We~dep~ .
U LTS:
Preseel
Presenl Absent
M.P.N To~l Coliform /IOOML
ICdiledl E:Coli IOOML
UNSUITABLE FOR ANALYSIS: IThis unsuitable sample must be replaced within 24 hours:)
[] Form Incomalete (see atta~ed *tem]
[] SamPle too 01~. not received within 30 hours of colleceon
[] Excessive chlonne present m samD~
. [] Unsuitable ~ntalner
~'1Heaw, nop-mlifo~ bactena/sllt present, ~ss~ely ooscunng and cdt/~pra~sing test results
[~.Q~.~nti~'t~o gr~e'a~o ~rmd agiO{ion
[] Quanl~ *~u'~clent for anal~ms (100 mi minimum