CF TownC P/C-LR 960429WATER BACT'~RIOL~
Form No. G-19 (Rev.
Dire ~ liml Rl~'d.
Texa~ Dep~tmant of ~
~ ' Bureiu of LIbOmto~
Wat~- of sa~ bac:I~mglcd quality mu~t be free from Coak)m~ orgm'~nm
"C} Found I"
UN~UITdM]t.~ FOR ~IdM.Y$18 -
(See enc~c~d ~em)
r-i Qum;ay Ir~ for aflalym
(100 mi. r. qutrod)
i-I
~ co,~-,~adatng te~t [.flub
WATER SACTERtOLOGY Texas Department of Health
Bureau of Laboratories
Form No. G-19 (Rev. 2/93) . , , ..
Date' J
Date and Time ReCd. ~' . .... '
Sample No. ,~ ~ , , . Reported
· ' ~ NAME'OF WATER SYSTEM
Water System I.D. No.
COUNTY
f! '
SEND ~i/71Fl£[,,,t b~,l, dul,'lSl I t t II I I I ii II I I t i'll
CiTY~ , ZIP CODE
TYPE OF SYSTEM
~'~ublic [] Dairy
[] Individual [] Bottled
[] School
[ SAMPLE IS
(P, ul~ic Systems Only)
[] DisSOlution [] R~w
./~Const~uction [] Re'peat
[] Spedal
WATER SOURCE
[] River [] Lake
[] ~all Well Depth
Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write
Water of satisfactory bacteriological quality must be free from Coliform organisms
Coliform Organisms j~ot Found
'[] Found
[] Total coliform group
[] Repe~ Samples required
[] Unsuitable ' See below
UNSUITABLE FOR ANALYSIS - PLEASE-RESUBMiT
[] Sample too old. SampLe not received [] Quantity insufficient for analysis
within 30 hours of collection
[] Date discrepancy or form incomplete
(See encircled item)
[] Leaked in fransit
[] Other
(100 mL required)
[] Heavy (silfoactedal growth) [xesent,
possibly compromising test results