Coppell Comm 1R3-LR040714City of Lewisville Laboratory
Water Bacteriology
Address
County
{Mo/Oa¥/Yr)
PO~nl of Collection CoJlected
Reporting ;'/~'~
STREET 2'
/,
TYPE OF [] Public ['"lln~iivid ual
SYSTEM: [] Other
SAMPLE [] ~lS~ibubon [] Special ~ C~slruction
IS:
[] Repeat for sample #.
[] Recheck Io~ samite #
[] Other ~
WATER [] ~ver ~"~ake [] Well
SOURCE:
UNSUITASLE FOR ANALYSIS: (This unsuitable sample must ~ rep/aced within 24 hours.)
[] Form Incmaplete (see atlached item)
[] Other
Analyzed by ': ~"/
City of Lewisville Laboratory
Water Bacteriology
,'"o,:~ l/ ~ g~ t/.~._.<
Reporti~
Address
TYPE OF ~blic [] Individual
SYSTEM: r-~other
SAMPLE [] Dismbu~uon [] Spec~l
IS:
[]Repeat for sample #
[] Recheck lot samite #
[] Other
WATER [] P~v~' [~ake [] Well
SOURCE:
Well depth Chlonne Re$idua~
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be rep/aced within 24 hours.)
[] Form Incomplete (see attachnd item)
[] O~er
Analyzed by '