Old Townhomes-LR040617City of £ewisville Laboratory 'I
Water Bacteriology ~
TYPE OF [] Public [] Individual
SYSTEM: r-I Other
SAMPLE [] D~stribugon [] Special
IS:
[] Repeat toe sample #.
[] Recheck [or sample #
/
WATER •~ver O~L~ke r-i Well ~'k~'/9 C
SOURCE:
Wall depth Chlorine Residual
ANALYTICAl MFTHOI3 & RESULTS:
(Colilet) E:Coli. Present Absent
MRN. Total Coliform __ /100ML --
UNSUITABLE FOR ANALYSIS' {This unsuitable sampe taus b~ rep aced w h n 24 hours.)
[] Form Incomplete (see attac~ed itam)
[] Sample Ioo old, not received wi~in 30 hours of co[lectio~
[] Excessive chi•fine present in sample
[] Unsuitable container
[] Heaw, no,¥co~ifo~n bactena/silt presentr possibly obscuring and cor~pro~ising test results
[]Other
Analyzed by.
City of Lewis. vllle Laboratory~ii
Water Bacteriology
Cop, o~ 11 ~,~ lcd_.
.tar System Ident~ficataon Num~L~
C,T~ [~LjO.~ T
TYPE OF ~[Public [] Individual
SYSTEM: [] Oth~r
SAMPLE [] Dstdbution [] Spedal J~ Const~dJe~
IS:
[] Repeat for sample #
WATER ORi~er ~ []Well ~"~'~ ~5-~: ~
ANALYTICAL METHOD & RESULTS: ~
<:~j~sent/Absent: ~ota~ ~c~orm '~ Present
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
[] Form ~ncomplete (see altached item)
[] Sample too old, not received witble 30 hours of collection
[] Excessive chlo~ne present in sample
[] Unsuitab[o container
[] Heavy, non-col,•tm bactend/silt p~esent, possibly obscuring and cempromisin9 test resu~
[] Quantity too great to permit agitaaon
[] Quantity insufficient for analysid (100 mi mleimum)
[] Other
Analyzed by
Water of saris[octal' quali[y should be lree of Cciiform Organisms
I
City of Lewisville Laboratory
Water Bacteriology
Address
TYPE OF
SYSTEM:
SAMPLE
IS:
E]~uU,c
City of I. ewisville Laboratorytii~
Water Bacteriology !'~,
(M~a~r~
WATER
SOURCE:
ANALYTICAL METHOD & RESULTS:
UNSUITABLE FOR ANALYSIS: ( This unsuitable sample must ~ replaced within 24 hours.)
[] Fo~m Iflcomplele (see attached item)
[] Sample toe old, not rec~ved witNn 30 hours of co~lectio~
[] Excesswe chlodne rxesenl in sample
[] Unsuitable container
i-'lO,her
AnaJyzed by
UNSUITABLE FOR ANALYSIS: ( T~is unsuitable sample must be r~placed wffhin 24 hours.) ~_.~
[] Form Inccmplele (see aitad~ed item)
[] Quantity insulSdent for anal)~is (100 mi minimum) ' ·
[]Other
Analyzed by