Gateway BP(1.5)-LR000626REPORT
TO: ST.F. ET:
i i~ SAMPLE DATE OOLLECT. TIME CHLORINE WATER ~ ~ ~ r-
NO. LOCATION COLLECT. BY ANMaM; RESIDUAL SOURCE -~ ~ m~ ~ .
3
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
FOR REJECTION:.
DATE/T]IVE 8TAMP
FI rFORM INCOMPLETE
OH - OVER HOLD NG TIME WHEN RECE VED
NAS - NOiR SPACE IN SAMPLE (t/2")
TNTC - TOO NUMEROUS TO COUNT
LABORATORY OFFICIAL:
FILTER LOT NO.:
MEDIA LOT
MF. MBRANE FILTER
COULERT PRESENCE#I~SENCE:
COLISURE PRE~NCE:
COLILERT QUANt I I ~u~Y
INHITE COPY: LABORATORY COPY
YELLOW COPY: MAILED TO CITY WITH FINAL RESULTS
'PINK COPY: SAMPLE COLLECTOI~S COPY