Coppell Industrial-LR010515 TARRANT COUNTY PUBLIC HEALTH LABORATORY
$800 University Dr., Ft. Worth. TX 70t07
WATER BACTERIOLOGY L,h No..BOt0 [8171871-724§
Dateand Time Rec'd. ~ ..... ,-- . Oam
Do Not M~Above This Line .--Please Print Below with BALLPOINT PEN OR TYPEWRITER:
/ NAME OF WATER SYSTEM
POINT OF COLLECTIONISAMPLE DESCRIPTION
Water System 1.0. No.
NAME ' -'~ /.
RESULTS sT'REET ADDRESS(P.0. Boxl TO: '
CITY ' / (Zip Code)
PBONE # DOUNTY
ICHI'I':Ii:I;I I I/1:1¢1×1
Collection Month Day Yea~ TIME AM)PM
TYPE OF SYSTEM SAMPLE IS
,~]Poblic E:]Dairy I~istributioo r--IRaw
E~lndividual E::] Bottled I--IConstruction [~Repeat
~School [:~]Vended i--~ GlycollSweetIChiH Water
[--IOther
Additionallnformation:
Collected By
WATER SOURCE
r~River r-'lLake
[--IWeil
Well Depth
Chlorine Residual ~
Total Coliform group
[] Escharichia coil
[] Repeat samples required
[] Unsuitable -- See below
LABORATORY REPORT (Do no write below)
TECH
Membrane Filtration (MF)
Coliform Organisms
[] Not Found
Found
Total Coliform1100 mi
£co~100 mi
Fecal Colitormsll OO mi
Unsuitable -- See below
MMO-MUG
Most Probable Number (MPN)
Coliform Organisms
[] Not Found
[] Found
Total
Coliform: MPN/10(]ml
E. co/k MPN/100mt
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Sample too old. Sample not received
· nthin 30 hours of cogection
[] gate discrepancy or form incomplete
(See encircled iteml
[] Leaked in transit
[] Quantity too great to permit agitation
[] Excessive chlorine residual: mglL
[] Quantity insufficient for analysis
(100 ~. required)
[] Reavy (siit~aactmial growth) present,
possibly compromising test results
[] Sample received on Friday
[] Other
H-220 .GPC-2190 REV. 6-97
"' TARRANT COUNTY PUBLIC HEALTH LABORATORY
'¥ 1800 U~ty Dr.. FL Worth. TX 76107
WATER BACTERIOLOGY.. LabNo. 48010Date (817)871-7240 'i,t
//~ Do Rot ?/Above This Line .--Pleaso Pflnt Below wffh SALLPOIRT PED OR T~PEW~iYER:
IIIIIIII
POINT OF COLLECTION/SAMPLE DESCRIPTION Water System LO. Ne,
RESULTS STREET ADDRESS (P,O. Box)
To: (;' e !/
' CITY ' / , (Zip Cedel
PHONE ~ COUNTY
Collection Month Day Yew TIME AM/PM Collected By
TYPE OF SYSTEM SAMPLE IS WATER SOURCE
,~3,pablic r--IDairy ~letribation []NOw []River []Lake
r-hndividual F-JBottled [-1CoP. structlen []Repeet r"lWea
I'--IScheol [-'lVeflded r'-i 61ycol/SweetIChill Water Well Depth
[] Other Chlorine Residu~
Addifionel Information:
no write bellwv) TECU
Membrene Filtration (MF) MMO-MUG
Meet Probable Number (MPN)
Coliform Organisms ColTferm 0rgenisms
.~. [] Not Found Not Fmmd
[] Found Fmmd
group Total Coliferr~lO0 mi Total
[] £$~icida~oll [.coli/lOOml Coliform: MPNIIOOmi
[] Repeat samples required Fecel Colfforms/lO0 nd E.. co/~' MPNIIOOmi
[] Unsuitable -- See below ~ below [] Unsuitable -- See below
UNSUITABLE FOR ANALYSiS-PLEASE RESUBMIT
[] Samp~to~ld. Smll~lenotrece~ed []
within 30 hours of collection
[] Date discrepancy or form incomplete []
ISee encircled hem)
[] Leaked in tT~sit []
[] Ouantity too great to peanut agitation []
[] Excessive chlorine residual: mp/L
0ueatity insufficient fef analysis
1100 mi. required1
Heavy {sit/bacterial growth) p~esmlt,
possibly compromising test reea0s
Sample received on Friby
Other
· ~.~ KCmm C. Tq~ D. r.~= ~.CMiK~