Securelock-LR040510SYSTEM:
SAMPLE
City of Le~isville Laboratory
Water Bacteriology
SOURCE:
(C~i~t)
[]
City of Lewisville Laboratory
Water Bacteriology
Water System Idenhfica~on Number
TYPE OF P~l Pub)lC ~ InolvlaUal
SYSTEM: C] Other
SAMPLE r~ Oismbubon [] S~eclal
IS:
[] Other
~tYAbJe~; Total C~,r~ ~ Presem n
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced w~thin 24 hours.)
[] Form Incomplete (see attached item)
[] Sample leo old, not received within 30 hours ol coqection
[] Excessive chlorine present in sample :
[] Unsuitable container
[] Heavy, non cohform bactenals~lt present, possibly obscunn§ ~'c~mprom ming test results
[] Quantity too great to permil agitatio~
[] Quan(i(y insufficient for analysis (100 mi minimum) '
[] O~her ~
Analyzed by
Water of sa[isfactory quality sh~d be Ir~e ol Colilorm Orgamsms