W Sandy Lk Addn-LR050912City of Lewisville .aD ratory
Water Bacteriology
TELEPHONE
(Mc/Day/Yr)
.2
TYPE OF [] Pu~tic [~'1'~ divid ual
SYSTEM: [] Other
SAMPLE [] Ditadb~tion [] Shecml [~'~Construot~on
IS:
[] Repeat ~or sample #
[] Recheck for sample #
[]other
WATER E~River [] Lake [] Well
SOURCE: We~l hepth Chlodne Res~Oual
(CollierD E:COti Present Absent
(ColilerD E:Coii. --/IOOML
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced
[] Form Incomplete (see aheched hem)
[] Sample too cid, not rece~ed whein 30 hours of cotlechon
[] Excessive chledne present in sample
[] IJr~ui~3ble container
[] Heavy, non-cohform hecieddsilt
[] Other
Analyzed by
Water of sattsfactoP/quality should be free of C olifom] O~gaotsms
City of Lewisville Laboratory-
Water Bacteriology
/ /'Name of Water S~tem County
Water System Idenbficahen Number
Point of Col~e~on Collected By Time
Re~rtir~g STREET ,PO .L'~.).¥ 2 ~ 7
TYPE OF [~P'~b~ic [] Indiv'dual
SYSTEM: [] Othe~
SAMPLE
IS:
WATER ' [] River [] Lake [] Well
SOURCE:
Well depth Chleflne Residual
p~_~W,CA[ uc~unn ~..~ULTS:
t/Absent Total Coliform~ Present __~ ~nt~..~
UNSUITABLE FOR ANALYSIS: ( This unsuitable sample must t~ ~eplaced within 24 hours.)
[] Form Incomplete (see tatashed item)
[] Sample teo old, not r~ceived within 30 hours of cobechen
[] Excesave chlorine present in sample '~
[] Unsuitable container
[] Heavy, non-coliform bactena/silt present, possibly obscuheg and compromising [est results
[] Other ~
Analyzed by
City of Lewisville Laboratory
Water Bacteriology
Water System IdentJflcabon Number:.
(Mo/Day.r)
'YPE OF [] Publ~ ~lf~'~ual
;YSTEM: E]Other
;AMPLE [] Dis~butlo~ [] Special
VATER [] R~er [] Lake [] Well
;OURCE:
Well depl~ Chlorine Residual
1 ~NAIYTI~At U[:THC)D&RFSULTS:
; re~t/A/)sent: Total Cetifonn~ Pre~t ~
(Colile~t) E:~Oll. present Absent
INSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced w~thin 24 hours.)
[] Other ~
~'~OP~Na m~/et Water System
Water System IdentJficabon Number:
TELEPHONE ~ ]
City of Lewisville Laboratory -
Water Bacteriology
Coun~
(M~Day/Yr)
TYPE OF [] PuI~ic
SYSTEM: [] Other.
SAMPLE
IS:
[] Ot~er
WATER [] River [] Lake [] Well
SOURCE:
Well dep~ Chlorine Residual
~al v'rl~,L IIPTHOD ~ ~E~ULTS:
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be~ep/aced within 24 hours.)
[] Form Incomplete (see attached item)
[] Sample t(x) old, not received w~[hin 30 hours of collection
[] Excessive chlodne present in sample
[] Other
City of Lewisville Laboratory
Water Bacteriology
~oin~ of ColledJon Collected By - ~me
(Mo/Day/Yr)
Billing NAME. ~v~_~ .._/
[~p Code)
TYPE OF [] Pu~ic ~ua{
SYSTEM: I~ Otber.
SAMPLE E) Dietfibut~3n [] Sbeoth [~'"~' Constructmn
IS:
[] Repeat for sample #
[] Other
WATER [] RJver [] Lake [] Well
SOURCE:
Weft depth. Chlpene Res,duts
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced wfihin 24 hours.)
[] Form Incomplete (see aitacbed item)
[] Sample too old. no[ received within 30 hours of coll~'tion
[] Excessive chlonne present in sampie
[] Unsuitable comolner
[] Heavy, non -cole'c~m bectenetsilt present, possibly obscunng and cor~oromising test results
[] Quantity t~o great to permit agitatJo~
[] Quantity insuffioent for a~alysis (100 mi minimum)
[] Other
Analyzed by
Water of satletocto~ quality should be free of Coliform Organisms