Northlake 635(3)-LR 980422· TARRAN~ COUNTY PUBLIC HEALTH LABORATORY ' '
?~ ' 180~ University Dr., Ft. Worth, TX 76107
WATER BACTERIOLOGY La, no. 48oto ist7~87t.Tz45
Date and Time
Sempin No.
Below with BALLPOINT PEN [
. ' NAME
RESmTS STREET ADDRE~S~(P.O. B~x)
Water Systml~ I.D. No.
-76 o 2'7
PHONE# ~ COUNTY-.,
Bate and
,imco,I_L kklP ': 1 1 1:1'14
I~ollectiofl Month Day AM/PM
EOFSYSTEM
~ic ~ [--~Uairy
r--Ilndividual [~Bottled
F-lSchool i'-IVended
Additional Information:
year ] TIME,,;. WATER SOURcEC°llected
, SAM~'LE IS
~'~tr~ution.. - - URaw U nlver ;'~ Lake,
[]ColstrkJction , i--1 Repeat
i--IWell
i--lG~ollSweetlChill Water Well Depth
r-'lOtlTer Chlorine Residual
LABORATORY I
Me~brane Filtration (MF)
group
[] Repeat samples required
[] Unsuitable -- See below
[] F'eund
Total Coliform/100 nd
Eeo///100 nd
Fecal Coliformell O0 nd
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS-PLEASE RESUBMIT
[] Sample too old. Sample not received
within 30 hours of collection
[] Date discrepancy or form incomplete
(See encircled item)
C:::] Leaked in transit
[] Quantity too Feat to pmmit a~tetino
[] Excessive chlorine residual: mg/L
H-220 GPC-2190
TECH
MMO-MUG
Meet Probable Number (MPN} ,4, _
Coliform Orga~oisms
[] Not Found
[] Fou~l
Total
Coliform: MPNIlOOnd
E. co~' MPN~I OOml
i'--I Unsuitable -- See below
[] Quantity insufficient roi' analys~s
(100 mi. required)
Heovy (silt~oactefild growth) preseflt,
possibly compomising test ruu~ts
[] Sample received on Friday
[] ot~f
~LIC HEALTH I~ABORATORY '
1800 University Dr., Ft. Worth, TX 76107
Lab No. 48610 (8171871-7245
~t r~ow with BALLPOINT PEN OR TYpBNRITER:
Water System I.D. No.
AM/PM Collected By i
~LE IS WATER SOURCE T
E]Row C]River i--]Lake .
[]Bepeef [~]Well
;hill Water Well Depth
Chlorine Residunl *
nO write below)
TECH
trot/on {MI:)
d Colfforn~lO0 mi
~100 mi
I Col~orms/lOOnd
Zeebe~w
MMO*MUG
Most Probable Number (MPN)
Coliform Organisms
I--1 Not Found -
[--I Found - --'~,
Total .
Coliform: ~ MPNIIOOml
E, co/J: __,MPNIIOOml
[] Unsuitable -* See below
~LEASE RESUBMIT
Quantity insufficient for analys~s
(100 mi, require~}
Heavy (silUbacterial growth) presmtt,
pessi~y compromising test results
[] Sample receive~ on Friday
[] Other
TARRANT COUNTY PUBLIC HEALTH LABORATORY
1800 University Dr. Ft. Worth, TX 76197
W/~ I~IACTERIOLOGY ~. LabNo. 480to 18t~B7t-72~
Date and TimeJ~,c'j~ : ' * ~ Dote
son,,.°. 00580[ ,
Do Not Mork Above This Li~e ---~PI~ Pri~l~ ~th BALLPOINT PE~ OR ~P~RITER:
~ POINT OF COLLE~ION
Water System 1.0. lk
STRE~ ~DDRESS ~.0. Bo~
PHONE ~ ' COUN~ .,
SEND
RESULTS
TO:
IZip C.odel
Date and
Time of
CoDectien Month Day
MinOF SYSTEM
[] Dairy
[]individual []Bottled
[]School []Vended
Year
. SAMPLE IS
(]~l~'st ributinn []Ra~
[]Construction r-'l Repot
~GlycollSw~t/Chili Water
~Ot~r
Additional Informatiou:
TIME
IZI Ikt ,l I
AM/PM Colle~ By
WATER SOUR~CE
~ []R~ver []Lake
' []Well
Well Dupth
Chlorine Residual
LAOORATORY REPORT (Do OD write below)
Membrane Filtration {MFJ
TECH
~-'~MMO-MU$
~l~". ~ Pf~unnceJAbeence
gaflisms
~] Total Coliform group
[] EsmeWc~ co//
[] Repeat samples required
[] Unsuitable -- See beJow
CoOform Organisms
[] Not ¢msM
[] Fmmd
Total ColifomVlO0 nd
£co///100 mi
__,Fecal Col/formal100 mi
[-'i Unsuitable -- See below
Most Probable Number (MPNP~
Colifo?~Organiams
[~ Not Fotee:l ,
[] Found .....
Total
Coliform: MPNITOOml
£.co/i: MPN/IOOmi
E~ Unsuitable -- See bebw
UNSUITABLE FOR ANALYSIS-PLEASE RESUGMIT
[] Sample te~ old. Sampbnotrecaved
w~thin 30 hours of coOectlee
[] Date discrepancy or to~m hlcomplet e
(See eflc~*cled item}
[] Leaked hi tronsit
~ Quantity too great to P~flT~t a~t atioo
[] Excesslve cMm'me res~ mg/L
H-220 GPC-2IgO
[] Quantity insufficient for analys~s
(100 nd. req~ed)
[] Heavy (silt/bact~ai ~owth} p~es~t,
possildy compromising test results
[] S~mple receine~ on Friday
[] Other
'BLIC HEALTH LABORATORY
1800 University Dr.. Ft, Worth, TX 76107
~ ', Lab No. 48010 (9171871-7245
~ T Cate
in, t~B~ slow With BALLPOINT PEN OR TYPEWRITER:
Water System I.D. No,
(Zip Code)
COUNTY
:E AM/PM Collected
1PLE IS i WATER SOURCE
r-JRaw '. F-IRiver [~ Lake
I'--IRepeat r'-IWell
/Chili Water Well Depth
Chlorine Residual
~ no write below) TECN
iltratirm (MF)
~al ColiformllO0 n~l
r/~'lO0 mi
al Coliform. si1 O0 mi
see below
MMO-MUG
Most Probable Number IMPN)
Coliform Organis. m
[] Not Found
E~ Found
Total
CoJiform: MPNIIOOml
£.cu&' MPNI100nd
[] Unsuilublo -. See below
PLEASE RESUBMIT [] Ouaubty insufficieflt for analysis
(100 mi. required)
[] Heavy (siltJbecteriei growth} ~'esmlt,
possibly compromising test results
[] Sample recsived on Friday
[] Other
TARRANT COUNTY PUBLIC HEALTH LABORATORY
~"~:~ E~ "~ 1800 Univer~'t~ DJ:.. Ft. Worth, TX 76107
WA ACTERIOLOGY' '~ '- Lab No. 48~0 (01~"71-7245
SampleNo. ' i :~ O' J 7 :
~ Do Not Mark Above ~is Line ---Plea~e~int ~ w~h BALLPOINT PEN OR ~PE~ER:
~[ OF WAT~ SYSTE~~
P01~T 0F COLLE~I0~
Date and
Time o~
CoIleed;n
Water System I.D. No.
TYPE OF SYSTEM ' SAMPLE IS WATER SOURCE
[]Public []Dairy r-I Oistdbetlon [--IRaw , []River []Lake
i'--Ilodividual E~Bottled []Construction []Repeat r-lWell
[]School []Veeded []Glycol/sweet/Chill Wate~ Well Depth
[]Othm Chlorine Residual
Additional Information:
LABORATORY REPORT (Do no write bldow)
TEOR
MMO-MU6
dde/Abonnce
, r-I Total Coliform group
[] E$cher/c/~b oo/i
[] Repeat samples required
[] Unsuitable .- See below
Membrane Filtration (MF)
CQlifbn, Organism
r-I Not: Found
[~ Fmmd
Total Coliform/100 rnl
E. cd~'lO0 fid
Fecal Coliform/lO0 mi
[] Un'liable -* See below
MMO-MUG
Must Probeble Number (MPN)
Coliferm Organisms
[] Not Found
[] Found
Total
Coliform: MPN/IOOed
E..co/~' MPNIIOOml
[] Unonitablo -- See below
UNSUITABLE FOR ANALYSIS--PLEASE RESUBMIT
[] Sample t~o od. Sample not received E~ Ouantity insufficient for analysis
w~thin 30 hours of collection (100 mi. requ~od)
[] Date discrepancy or form incomidete [] Heavy (silt~act~ei growthl p~eseflt,
ISae mlcimied iteml pusseS/compromising test resuHs
[] Leaked in tra~t [] Sample received on Friday
[] Ouantitytoogi'eattopmll~a~tation [] Other
[] Excessive cMo~ ;esJd~J~ "- ntO~[