Community CU-LR021212Wmler ~ IdMdllleaUon Number
O~
SYSTEM: I-I O~her
SAMPLE D D"~dbutlo. I-I spe~l
IS:
D RePack for ~lo f
I-I O~her
WATER D R~ver ~"/~k~ [] Wel
SOURCE:
Wal ~
~nsUucllon
Chlod~e Residual
~ESULTS:
Present
(Cotflert) E:Coli. Present
M.F~N. Total Coliform
(Co~ert) E. Coll.
Memb~tneFJMr/Fm~lCo#fo~n: 1si D#. /
Absent
__JIOOML
Avg. I mi
Unsuitable For Analysis:
[] Fom~ Ineomp~e (me m,,,;.,;~l #em)
D Smq)b too oM, nol meMved w~hi~ 30 houm of eolection
D
[] M kllull~dM~l fo~ &'u~lYals (100 mi mkmrlom)
CITY OF LEWISVII]F LABORATORY. WATER BACTERIOLOGy
Point of Co#ecflo~
Billing/ NAME
Repofllng
Addt'ess:
County
'~otlected By Dale Time
(U~D~W)
STREET 0 ~y (/~
TELEPH~E( ~).~ ~64 -~t~~1
Waler System I~ntlflcalion Number
SYSTEM:
SAMPLE
WA~R
SOURCE:
' ~RESU[IS:
M.P.N. ToMI ~iform II~L
Avg. /_____mi
Unsuitable For Analysis: w ~
D Folm IncompMe (ll~ ~,~,-G,~ J Nero)
[] Sampk Im okJ. llol ~ wilhln 30 hm~s of ooltectkm
[] Unsub~
I-] Oum~lty too ~rOal lo pMm~ &gMio~
[]~] Quanll~ imwlt~teM fm analysis (100 mi rr/~nUm)other ~! tV '