TexasBank 2R-LR050428City of Lewisville Laboratory
Water Bacteriology
County
(Mo/Day/Yr)
Address
T~PE OF ' []~ Public []Individual
SYSTEM: [] Other.
SAMPLE [] D~stribu~on [] Special ~] Construction
IS:
[] Repeat fo~ sample #
WATER [] R,ve~ ~ Lake [] Wel~
SOURCE:
UNSUITABLE FOR ANALYSIS: ( This unsuitable sample must be replaced within 24 hours.)
[] Form Incomplete (see a~ached ilem)
[] Sample too old not received within 30 hours of co41ec~on
COPPELL
Department of Public Works
Initial Date: May 06, 2005
Final Date:
Created By:
WOWA-05-2272
Water
Name
Address
Cross Street
Location
Description
Water On or Off
Kckk Utility Const. (H) [] Left Door Knocker
(W) [] Spoke to Resident
300 S Denton Tap [] Called Resident
Notify Water Billing
Bacteriology report attached. They want water turned on Monday 8:00 a.m. 5/9/05.for Creme De
La Creme.
Office Comments
Assigned To
Old Meter #
Reading
New Meter #
Reading
Personnel Assigned Hours
Field Comments:
Quantit
Parts - Equipment Used
Signature: ~/,~'~ ~'~
Date:
P.O. Box 9478 - 8t6 S. Coppell Rd - Coppell, TX 75019 - Phone (972) 462-5150 - Fax (972) 462-5155