Fairways-LR 930831WAIER BACiERtOLOG'f Texas D Dartmen[ of Health
Form No. G-1.9 ("Rev. 12~911 ___~-t~b°rat°ries
~¢ ,a~ ~an~ ~ ~'h~e .R,,ec'd. ' ' Date
o not mark above this ~he ~'Please print With b~flpo ct ~ o ~p~r
Water System I.D. No. NA~E OF WATER SYSTEM
SEND
POINT OF COLLECTION COUNTY
SubmitterLD. No.I Il i Ill I J
NAME
STREET ADDRESS IP.O. Box)
CITY ZiP CODE
Date and -¢ ·
Timeof ~)1~'1
Collection
MONTH DAY YEAR TIME AM/PM COLLECTED BY
TYPE OF SYSTEM SAMPLE IS
(Public Systems Only) WATER SOURCE
[~'Public [] Dairy [] Distribution [] Raw [] River [] Lake
[] Individual [] Bottled [~""C'onstructian [] Repeat [] Well Well Depth
[] School [] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below)
Water of satisfactory bacteriological quality must be free from Coliform organisms
Coliform Organisms ~,.Not Found
[] Found ~
[] Total coliform group
- ~ Fecal colif~_g~up~
[] Repeat samples required
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old. Sample not received
within 30 hours of collection
[] Date discrepancy or form incomplete
(See encircled item)
[] Leaked in transit
[] Other
[] Quantity insufficient for analysis
(100 mL required)
[] Heavy (silt/bacterial growth) present,
possibly compromising test results
WA1 ER BAC l ERIOLOG¥ ~ exas De &rlment of Heaith
Bum~,~horatories
Form No. G-~91~ev. 12/~,~
; ~ ~ ~- .: '-z ;~o not mark above t~s li~e~ Ple~e print with ballpoint pen or ~pewriter.
Water System I.D. No. NAME OF WATER SYSTEM ~/~¢/~
POINT OF COLLECTION COUN~
S~b~,t~,~.D.~o. ~ I I I I I I I ~
SEND ~1~171~1~1 ~I~I~P~>~ I I I I I I I I I { I I ~ [ I I ~
NAME
RESULTS ~/iOi I>1 I~1~*~1 I¢1~1 I I I~ I I I ~l~l I I I I I~ ~
STREET ADDRESS (P.O. Box)
TO: ITx
ZIP CODE
Date and
Collection
MONTH DAY YEAR TIME AM/PM COLLECTED BY
SAMPLE IS
TYPE OF SYSTEM (Public Systems Only) WATER SOURCE
[~'tS~ublic [] Dairy [] Distribution [] Raw [] River [] Lake
'[~ Individual [] Bottled ~!~nstruction [] Repeat [] Well Well Depth.__
[] School [] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below)
Water of satisfactory bacteriological quality must be free from Coliform organisms
Coliform Organisms ,j~[qot Found
'[] Found ~
[] Total coliform group
[] Fecal coliform group
[] Esche~ichia coli~ ~
[] Repeat samples required
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old. Sample not received
within 30 houm of collection
[] Date discrepancy or form incomplete
(See encimled item)
[] Leaked in transit
[] Other
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy (silt/bacterial growth) present.
possibly compromising test results
WATER BACT~:RIOLOG¥ Texa-~'l~mtment of Health
Form No. G~l,g (Rev. 1/r~, Bure~Laborator es
Do not mark above this line -- Please print with I~allpolnt pen or typewriter,
Water System LD, No. NAME OF WATER SYSTEM ~:~ ,~/'~./J ,ar ~/..
POINT OF COLLECTION COUNTY
STREET ADDRESS (P.O. Box)
CITY 7JP CODE
Collection MC)NTH DAY YEAR TIME AM~PM COLLECTED BY
TYPE OF SYSTEM SAMPLE IS
(Public S~terns Only) WATER SOURCE
~"Publio [] Dairy [] Distribution [] Raw [] River [] Lake
[] Individual [] Bottled L~onstruction [] Repeat [] Well Well Depth
[] School [] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below)
Water ot satisfactory bacteriological quality must be free from Coliform ofl~anisms
[] Total
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old, Sample not received
within 30 hours of colleot~pn
[] Date discrepancy or form Incomplete
(Soo encircled item)
[] Leaked in transit
[] Other
[] Quantity insufficient for analysis
(100 mi, required)
[] Heavy (siit/bacterlal growth) present,
possibly compromising test results
Form No. 6-1 ('Rev. 12/ 1 Burea~n~ratories
! · Do not ~ir~ above thls line -- ¢Je~¢ pdn( ¢i~h'ballC~oCdt ~r~ ~r ~ewriler.
Water System I.B. NO. NA~ OF WATE~ SYSCEM ~¢~
POINT OF COLLECTION ~ , OOUN~
STREET ADDRESS fP.O. Box)
CI~ ZIP CODE
Date and
Time of
Collection
MONTH DAY YEAe
TYPE OF SYSTEM
[~Sublic [] Dairy
[] Individual [] Bottled
[]School
TIME AM/PM COLLECTED BY
SAMPLE IS
(Public Systems Only) WATER SOURCE
[] Distributio~--¢ [] Raw [] River [] Lake
[~'~struction [] Repeat ~ Well Well Depth
~ Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below)
Water of satisfactory bacteriological quality must be free from Coliform organisms
Coliform Organisms L~.Not Found
~_J Found ~
[] Total coliform group
[] Fecal coliform group
[] Repeat samples required
[] I~nsuitable -- See below
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old. Sample not received
within 30 hours of collectlon
[] Date discrepancy or form incomplete
(See encimled item)
[] Leaked in transit
[] Other ~
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy (silt/bacterial growth) present,
possibly compromising test results
Water System I.D. No. NA~OF WATER sYsT~
STREET ADDRESS fP.O. Box)
Cl~ ZiP CODE
Da~ and
Time of
Collection
TYPE OF SYSTEM
~ublic [] Dairy
[] Individual [] Bottled
[] School
SAMPLE IS
(Public Systems Only) WATER SOURCE
[] Distribution [] Raw [] River [] Lake
[~o/~'truction [] Repeat [] Well Well Depth_
[] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below}
Water of satisfactory bacteriological quality must be free from Coliform organisms
Coliform Organisms [~ Not Found
L.j Found
[] Total coliform group
[] Fecal coliform group
[] Repeat samples required
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old. Sample not received
within 30 hours of collection
[] Date discrepancy or form incomplete
(See encircled item)
[] Leaked in transit
[] Other
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy (silt/bacterial growth) presenti
possibly compromising test results
WA I-ER BAGfEHIOLOGY ?exas Department of Health
Form No. G-1,9~ (l~ev. 12/,9,9.~ Bure~n,,i~2horatories
[~a15 aneTime R~c'd, . ' · Date
- 'b~ ~ot m~~s. print Wlth ~i~t
NAME
STREET ADDRESS (P.O. Box)
CITY ZIP COBE
Date and
TimeofI ,¢1 =FTl l'
Collection
MONTH DAY YEAR TIME AM/PM COLLECTED BY
SAMPLE IS
TYPE OF SYSTEM (Public Systems Only} WATER SOURCE
[~ublic [] Dairy [],Distribution [] Raw [] River [] Lake
[] Individual [] Bottled ~struction [] Repeat [] Well Well Depth___
[] School --, [] Special Chlorine Residual
Ownership or other information:
LABORATORY REPORT (Do not write below)
Water of satisfactory bacteriological quality must be free from Coliform organisms
Coliform Organisms ,,~Not Found
~U Found f
[] Total coliform group
[] Fecal coliform group
[] Esehefichia coli~
[] Repeat samples required
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
[] Sample too old. Sample not received
within gO hours of collection
[] Date discrepancy or form incomplete
(See encircled item)
[] Leaked in transit
[] Other
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy (silt/Uacterial growth) present,
possibly compromising test results
Texas artmonl of Health
WATER BACT~;RIOLOGY
Form No. G/1'9 (Rev. 1/~ BureaJ~;aboratodes
Date an~ Time R~c'd. ~ ' ' Date ':~r~ ~,~ ·
W~er SYS em D No. -~ ~ --~AM~F WATER SYSTEM ~o~//
RESULTS
TO:
STREET ADDRESS (P.O. Box)
ZIP CODE
Date and
T, meot I ,'1
Collection
TYPE OF SYSTEM
[] De ,¥
[] Indiv;dual [] Bottled
[] School
TIME AM~M COLLECTED BY
SAMPLE IS
(Pub~ Systems Only) WATER SOURCE
[] DIstflbutlon [] Raw [] River [] Lake
[~,'C~'-onstruction [] Repeat [] Well Well Depth
[] Special Chlorine Residual
Ownership or other information:
LAIIIORATORY REPORT (Do not write below)
Water of satisfactory~bacteriolog~cal quality must be free from Coliform organisms
Coliform Orgenllm$ [~'Not Found
~-Found
[] Total
[] Fecal
*.--"? . ~. [] Repeat~n~Jes reOpired - -
[] Unsuitable See below
' UNSt~TABLE FOR ANALYSIS - PLEASE RESUBMIT
[] semple~to0 ~1~1. sample not received . n Quantity insufficient for analysis
within 30 hours of collection
[] Date discrepancy or form incomplete
(See encircled item)
[] Leaked In transit
[] Other
(I00 mi. required)
[] Heavy (silt?oacterlal growth) present,
possibly compromising test results