Gibbs Station 1-LR 921005 (2)Form No, G-19 (Rev. i2/91) .... ~,~; Bureau of !-~a~
,
Cl~
Date and
Time of
S
(Public ~/~tems O~ly) WATER SOURCE
__. [] Distribution [] Raw [] RIver [] Lake
~_ ~ction [] Repeat []Well Well Depth
~,,. = ~'wnership or othat inform~on: ,/-' . .
, ~*,-~ ~ Water of satisfacto rfol i ) '
.~._.. , . . . og . t b~ free from Coliform o anism
UNSU~ABLE FOR ~YSIS - P~E RESUIM~
30 ~um ~ milton
~ Dae d~ ~ ~ i~mplete