Freeport NIP(2.8)-LR040714City of Lewisville L aboratory
Water Bacteriology
Water System Identification Number
Point ot Collectio. Oollected By
Billing NAM*~
OPM
SAMPLE C'lDistdbution [] Special []~'~'~Construction
IS:
[]Repeatforsam~e#
[]Recheckforsample#
[]Other
WATER [] River
SOURCE:
Well depth
Chlorine Residuat
ANALYTIC. A[ METHOD&RESULTS:
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
[] Form Incomplete (see at~ached item)
[] Sample too old, not received within 30 hours of coliec~on ~
[] Excessive chlorine present in sample
[] Unsuitable conlainer
[] Heavy, non-coliform bacleriaJsib present, possibly obscuring and compromising test results
[] Quanaty too great to permit agilation
[] Quantity in&u f~cient [or analysis (100 m[ minimum)
[] Other ~
Analyzed by
City of Lewisville Laboratory
Water Bacteriology
~/~/ NameofWaterSystem
Water System Identgicaoon Number:
Point of Coilecbon ColJectpe By
Billing
County
(MolDay/Yr)
TYPE OF [~blic [] Individual
SYSTEM: [] Other
SAMPLE
IS:
[] Distribution [] Special ~""'~onstrucPon
[] Recheck lot sample #
[] Other
WATER [] River [~L~e [] Well
SOURCE: - '
Well depth Chlohne Residual
ANALYTI~ULTS:
.~__.~esent/Ab~ To~al Cohform~) Present ~
(Colilert) E:CO~i Present
MP N Total co~gorm --/IOOML '- -
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must ~e replaced within 24 hours,)
[] Form incomplete (see attached item)
[] Sample too old, not received within 30 hours of collection
[] Excessive chlorine present in sample
[] Unsuitable container
[] Heavy, non-coliform bacteria/silt present, possibly obscuring and compm~nising test resuds
[] Quantity insufflctent Ior analysis ( 10g mi minimum i '
Analyzed by. _~
Water of satisfactory quality should be flee of Colilorm Orgamsms
City of £ewisville Laboratory
Water Bacteriology
~' Name of Water Syslem
Reporting STREE~ '~'~ ~__~.~u
Address CiTY./~¢*//'~'' ~t~.[ 6, t TEXAS
County
TYPE OF
SYSTEM: E] Other
(Mo/Day/Yr)
SAMPLE [] Distrit~tion [] Special ~ Constr~.f~on
[] Repeat fo,' sample #
[] Recheck for sample #.
[] Other
WATER [] River ~ake [] Well
SOURCE:
Well deplh Chlorine Residuat
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be re ~laced within 24 hours.)
[] Form Incomplete (see attached item)
[] Sample too oJd, not received within 30 hours of c.¢lection
[] Excessive chledne present in sample
[] Unsuitable container
[] Heavy, n0n-colil0rm bacteria/siP present, possibly obscuring and c~omi~ing tes~ results
[] Quantity too grea~ to permit agitation
[] Quantity insuffmc~ent for anaysis (100 mi minimum)