Amberpoint-LR020515 r,~,~
OF
SYSTEM: D ~he~
SAMPLe" ~-.
IS~
~ Recheck ~r ~mple
FAiR ~ R~r
Well ~plh
~enVAbsent' TOt~
'." .
CITY OF LEWISVILLE LABORATORY - WATER BACTERIOLOGY
'~ NL~me of Wafer Symem ~* County .._._..
a, L
=,oint of Collection Collected By Dale '""~'"
Billing/ NAME (~-~ ~.- ~'//g~/~ ~::~/9~']~ 1~/' [)/~- .~
Repolling 'STREE~g~/~,{,,(qp,~ '~- ~
Address:
CITY
OF " ~'
SYSTEM: [] other. ~
SAMPLE [] Distribution [] Special ~ '~Construction ~
IS: _. o
[] Repeat ~ot sample #
WATER ' ~ R;ve I~ Lake
SOURCE: L.J t
ANALYTICAL METHOD & RESULTS:
sent/Absent: Total C~ Present
lilert) E~ Present
MP.N Total Coliform
(Colilert) . .. I~. CoIL
I100ML
Unsuitable F?r Analysis: _i' ,z= ·
[] Fora1 In~e (see encircldd item)
[] Sample too old. nol received ',~1 h~n 30 holm of
[] Exeessive chkxine ~esenl in sample
[] Heavy. no~ colifonn bacleda/sil~ present, poss~ly~ob~cuflng and compromising test results
~ Quanlity insult<tern fo~ analysis (100 n~ ninmum) ·
[] other ?, '
Ar,.a~yzed
ClTY OF LEWlSVILLE ~
· Counly
Dale
Reporting
Water System I~nlifl~tion Number
~PE ~ublic ~ IndN~ual
OF
SYSTEM: ~ ~her :.
SAMPLE [] Distribution [] Special
IS:
~ [] Repeal Ior sample #
[]Recheck for sample #
[] Other
~Constructiort
WATER [] River [] Lake [] Well
SOURCE:
Well depth
ANALYTIC~AL METHOD & RESULTS:
.~'.~,~resentJAbsent: Total Co~ Present
· (Colilert) E:Coli. Presenl
M,R N, Total Coliform
(Coliiert) E. COIL
/IOOML
BACTERIOLOGY
i
Un'suitable For Analysis: :
[] Fon'n I~e (see encircled item)
[] Sample Ioo oki. no~ received wflhin 30 ho~m of c~lecUoa
[] Excessive chiodns presanl in sample *~' -
[] Unsuitable ce~lainsr
[] Heavy. non coltfon~ bacteria/sill Ixesant, possibly obscuring and comprom~ng lea resutls
[] Quantity Ioo greal to permil agitation
[] ouan~,in~u~n~ ~- anal= (100 m~ ~nrnum)
CITY OF LEWISVIU. E LABORAT(~RY - WATER BACTERIOLOGY
~ Col~t~ By'
Balin~
Re~ing
A~r~: STREET
CITY
Wat~ Sy~em I~ntlfi~tion Numar
TYPE ~ubllo [] II~dividual
OF
SYSTEM: [] Other
SAMPLE [] Dmrlbulion [] Special .,~or~structlon
IS:
[] Repeat for sample #
[] Recheck for sample it
[] other
WATER [] River '~:J--I Lal~~' J~Well ~)~--~'/~-~
SOURCE.~ ; .
Well depth Chlorine P~etdual
ANALYTICAL METHOD & RESULTS:
~'-Pr~;ent/Absent: Total Coliform~ Present
(Colirer~) E:Coli. Present
M.P.N. Total Coliform
(Colilert E. CoIL ~
Membrane Filter/Fecal Colifon'n: 1st Di~.
Unsuital~e F?r Analysis:
[-J Fol'm Inc~a (see encircled itam)
[] Sample too old, ~ received ~ilhi~ 30 houm of
[] E~-~. ~ ct~dne pmsem in samp~
0 Unsu~ble =xaain~ : "
0 Hsaw,'Jhon colil°m~ bacleria/sill IXeSeN, P°a~/~ly~ bacudng and com~om~ng te~ results
[] Quantity IOO great to ~ agitation
[] Qua~ insu~i~t ~ ana~mS (100 m~ rninrnum)
0 Other *
^na~zed by ~.~.-