Freeport NIP(8.0)-LR041216City of Lewisville Laboratory -
Water Bacteriology
TYPE OF [~P~ic [] indiwdual
SYSTEM: E] Other
SAMPLE [] Distribution [] Special ~ Construcl~n
)S:
[] Repeat ~or sample #
[] Recheck lot sample #
[] Well
Chlonne Residual
ANAlYTICAl M~:TU09 ~ R~:SULTS: ~,...~h~,nI ~
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
[] Fom~ inco~Aolete (see atiached item)
[] Sam~le toe old, no{ received w~thin 30 hours of collection ·
[] Excessive chlohne present in sample
[] Unsuitable container
[] Heavy, non-cohform bacteria/silt ~'e;enL possibly obscunng and compromi;ng test results
E] other ~__~./~//
Analyzed by
City of Lewisville Laboratory
Water Bacteriology
, ,' Name olWater System
Water~deotificapen Number
Point OI ~ol~eCbon ~ cogected By Date
(Mo/Day/W}
Address c~w / -/~ '*''~: ~ TEXAS
TYPE OF E~Pubiic [] individual
SYSTEM: []Other
SAMPLE [] Distribution [] Special ~ Construction
)S:
[] Re,eat Ior sample #
[] Recheck lot sample #
[] Other
WATER [] River ~t~a ke [] We~l
SOURCE:
Well depth Chlorine Residual_
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be ~
[] Form Incomplete (see [a[ached item)
[] Sample too old, not received within 30 hours ol collection
[] Excessive chlonne present in sample
[] Unsuitable container
[] Heavy, non-cohform bac[analsilt present, possibty obscu~ng and comp
[] Quantity tad great to permit agitation
[] Other
Analyzed by
Water of satisfactory quality should be Iree ol Co
Sample Numper: Laborot Dry ID NudiSm pe~=48146 ' Comments:
~(~,~ q~) Laboratory Name: City ot Lewisville
Dale and Ti~ Sample Received Date and Ti~ Analysis Began: Date and Time Re~ded: