Villas at LV-LR050809City of Lewisville Laboratory
Water Bacteriology
(Mo/Day/Yr)
~YPE OF [] Public [] Indiv~ual
SYSTEM: [] Other.
SAMPLE
IS:
WATER [] R~'er [] Lake [] Well
SOURCE:
We~l depth. Chlonne Residual
~p~re~ YT[r:~4~THOD & RESULTS:
MPN. Total Coliform __ IIOOML
UNSUITABLE FOR ANALYSIS: (This unsuitable sample mustT~e rep/aced within 24 hours,)
[] Other ~
City of Lewisville Laboratory -
Water Bacteriology
'VILLi~ ~.T kr, l~ v~'t
Name of Water System
County
Water System Identification Number
TYPE OF [] Put~ic [] individual
SYSTEM: [] Other.
SAMPLE [] Dtstdbofion [] Spedal ~ Consfcucflon
IS:
\
WATER [] River [] Lake [] We~
SOURCE:
Well depth Chlo~ne Residual
t Total Coliterm~ Present
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
[] Fon~ Incomplete (see attached item)
[] Sample too old, not received ~n 30 hours of collection
[] Excessive chlo~ne present in sampte
[] Unsuitable container
[] He, aW, ~on~dite~m bacte~a/silt present, possibly obscunng and compromising test results
I~ Other t~//
Analyzed by
City of Lewisville Laboratory
Water BacteriologY .
TELEPH(~E
TYP~ OF [] public
sYSTEM: [] Other
SAMPLE
IS:
[] DisU~utien [] Special ~!~
[:] Recheck ~ sampfo # ~
~ Ofher
WATER [] River [] Lake
SOURCE:
Wstl dep~
Chlonne Readual
AN~_P. AI IdFT.nn ~. nFSULTS: ~ Ape~t "~
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must b~ ~e~laced within 24 hours.)
[] Fon~ Incomplete (see attached item)
[] Unsuitable contan~
[] Other
Analyzed by
City of Lewisville Laboratory
Water Bacteriology
(M~ay~r)
TYPE OF [] Pubtic [] Individuai
SYSTEM: [] Oth~
SAMPLE []Dismbution [] Special ~ Ce~s~Jon
IS:
[] Re~eet for sampte #
[] Recheck f~x sample #
WATER [] River [] Lak~ [] Well
SOURCE:
WeB dep[h Chlonne Residual
LTS:
(Coliled} ~:L;OlL Present
UNSUITABLE FOR ANALYSIS: (This unsuitable sample mus~ be replaced within 24 hours.)
[] Form Incomplete (s~e attached item)
[] Sample too old, not r~ceived wilhin 30 hours o~ cofl?c{ion
[] ExCeS~ve chionne present in sample
[]Ot~r
Analyzed by