Grand Cove-LR 940803 ' . - ( ev. 12/91) ~..,.o~,_~,~,.~-. Bureauofl=h~r~nn~ ~
Date and Time Rec'd. . ~ ~ ("~ 'J ~
~gle~N~._ _ ~,,R~ ' ~ '
0 1 l'5 ~'~,ma~vethisl~.t~b~n~~ ~
water ~y~em I,D. No, ' .. NA~E OF WAT~ fl~ ~
~RE~ ADDR~ [P.O. ~x}
TO:
ZIP ~
~PE OF SY~EM SAMPLE ~
(Public Sy~ems ~) WA~R ~U~E
~ ~ D~ ~ Distd~tio~ ~ Raw ~River ~ L~e
~ IndMdual ~ ~ffied ~s~u~on ~ Re.at ~ Well Well
~ ~h~S ~ S~I C~dne R~i~a
~ ~ o~er i~o~aflon:
I
Coliform Organisms
Found
[] Total coliform group
[] Fecal coliform group
[] Esche~chia coil
[] Repe~t samples required
oman~sms
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
r--~ Quality insufficient for analysis
(1{)0 mi. required).
,[] Heavy (silt/bactmtsi growth) prat,
possibly compromising test results
[] Sample too old. Sample not received
within 30 hours of collection
[] Date discrepancy or form incomplete
(See ancimled item)
~ O~er '"'
FWo~LNo~. _~9Tl~F~leOv~.lO2j~'~ ~ Texas Depadment of Health
) ~i~
~ ' ~ / ri'Bureau of Laboratories
Date and Time Rec'd. ~
Sample No. Re~ed
' R FI 5 ~`m~vethisll~e'~t~'~l~Or~p~dter'
mira OF ~LECTIm
Submla~l.O.N.. I I I I I I I I I
SEND NAME
STRE~ ADDRESS (P.O. Box)
Cold.ion ~N~ DAY ~ TIME
~E OF SYSTEM
(P~lic
~u~ic ~ De[~ ~ DisEibu~on ~ Raw ~ River ~ L~
~l~i~du~ ~1~ ~ns~on ~R~ ~W~I W~lDe~ ,
~ ~hool ~ S~d~ ~lo~e R~i~
~emhip ~ other i~ormafion:
~TORY ~
Water of ~a~dol~ ~
~,lform ~ganl.m. ~ot~ FoundF°Und
~ T~ ~lif~m gm~ ~ F~I
~ R~at sa~s r~uired
~ Unsu~le ~S~
U~UITA~E FOR ANALYSIS - PLEASE RESU~IT
~ Sarape ~o o~. ~ple ~ r~eiv~ ~ ~ ip~ ~ ~ysis
~in ~ ~um of milton (1~. r~ui~
~ ~te ~e~ o~ form ~e ~ ~{~ ~o~) ~nt.
(~e ~ ~)