TexasBank 2R-LR050428City of Lewisville Laboratory
Water Bacteriology
~" ~;~ ~ F'~a~me~of Water System
Water System Identification Number:
Point of Collection Collected By
Billing
Reporting
Address
Ccunty
TYPE OF E~] Public
SYSTEM: [] Other.
Fhndiviclual
SAMPLE [] Disthbation [] Special ~ Constru~on
IS:
[] Repeat for sample #.
[] Recheck for sample #
[] Other
WATER [] River ~] Lake [] Well
SOURCE:
Well depth Chlonne Residual
~LTS:
Present ~
(Coiilert) E:Coii. Present Absent
M.RN. Total Coliform __ /10OML
(Coltied) E:Coii. -- /10OML
Avg f mi
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
[] Form Incomplete (see attached item)
[] Sample too old, not received within 30 houm ol collection
[] Excessive chlorine pcesent in sample
[] Unsuitable container
[] Heavy, non~coli['orm bacteria/silt present, possibly obscuring and compromising test msetis
[] Quantity too gmat to permti agitation
[]Quantity insufficient for analysis (100 mi minimum)