Coppell Comm 1R3-LR040716City of Lewisville Laboratory
Water Bacteriology
(Mo/Oay~r)
TYPE OF ~l~ublic [] Individual
SYSTEM: [] Other
SAMPLE [] Distnbutm
IS:
[] Repeat f~r sample ~1
[] Recheck for ,~
WATER [] Ri~er
SOURCE:
Well d
[] Unsuitable
[] HeaW, non-coliform
[] Ouanbty [oo gmat tc
[]Quantity
~lOtner
s (100 mr minimum) ~. ~,
Analyzed by ·
Water ol satisfactor7 quality should be free of Coliform Organisms
City of Lewisville Laboratory'{
Water Bacteriology
Address
T,~- ~
(MolOay/Yr)
Billing NAME
Reporting STREET ,
TYPE OF [] Public [] Individual
SYSTEM: r~ Other
SAMPLE [3 Disb~buhe~ [] Special [~'"- Constrqc(Jon
IS:
[] Repeat fo; ;ample #
[] Recheck for sample #
[] Other ~
WATER [] River ~ake [] Woll
SOURCE: ~ ' '
.._ANALYTIRAI MF"rHO9 E c'E.~LTS:
Present/Absent: Total Coliform,=.,)Presenl ~
(Coliier~) b:L,"~l Present
MEN Total Coliform /100ML - -
UNSUITABLE FOR ANALYSIS: ( Thl~ unsuitable sample must b~e replaced within 24 hours)
[] Form Incomplete (see attached item)
.7?