PA9901-LR021028 TARRANT COUNTY PUBLIC HEALTH LABORATORY
1EOE University Or., Ft. Werth, TX 70107
WATER BACTERIOLOGY hb #0.48010 1817)87t-7245
Sample Ne. I ~ i : ~,,~
Do Not Mark Above This Urn0 -~l~e ~nt B~ ~ BAL~OINT PEN OR ~PE~ER:
RAME §F'WATER SYSTEM ~M/'~ ~"~W"~ ~
POIRT OF COLLECTIONISAMPLE DESCRIPTION
NAME
SEN. P.O. 6*t ~t
RESULTS STREET ADDRERR (P,O. Rex)
TO: H ;J Io~LC,,~ Tx 'f~.o~
CITY (~p Co~)
Oate and
Time of
Collection Month Day
TYPE OF SYSTEM
[~P~lic []Dairy
r"hndividual r--IBotOed
[::]School r--lveflded
I1 1 11o1 I 14/1:1,tol H I I
Ye~ TiME AM/PM Collected By
SAMPLE IS WATER SOURCE
[]Distribution ['"]Raw r-]River r"'lLake
[~truction r-lRepeat []Well
[] GlycollSweetlChill Water Well De0th
[]Other Chlorine Residual
Additionallnformation:
LABORATORY REPORT (OD no write belowl
TECH
MMO-MUG
PreeencelAbaence
Membrane Filtration (MF)
Foumi O~ganis~_~/ Coliform OrMnisms
r--I Fo4md[] Not Found
[] Total Coliform group Total Ce~fem~lO0 mi
[] E~rcAw,,7~/dJ co/i E..~o///100 mi
[] Repeat samples required __Fecal CorlformsllO0 mi
[] Unsuitable -- See below . [] Unsuitable *. Sc.e balew
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Sample tee oM. Samlde not received
within 30 hours of collectim~
[] Bate discrepancy ~ fomt incomp~e
(See mlciroMd item)
[] Leaked k~ tra~
[] Ouantity tee Oreet to peflllit a~tatiofl
[] Excessive ch~e res/alu/n: mg/L
MMO.MUG
Me~t Probable Number (MPN)
Celiform Organisms
[] Not Fmmd
[] Found
Total
Coliform: MPNIIOOmi
E. co//: MPNIIOOml
. [] Unsuitable -- See balew
H-220 GPC-2190 REV. 6-97
li O0 mL req~ed)
[] Heavy (sdubactefinl powthl p'esmt,
pORSl~y Cmllp~fllis&~ test results
[] Smllple received mt Friday
[] otmp