Town Center West-LR010627CITY OF LEWISVILLE LABORATORY - WATER BACTERIOLOGY
Billing/
Repo~ling
Address:
/~/ Name of Water 8ystam County
Point of Cellectlon I D&te Time "
(Mo/Day/Yr)
~ELE~HO~E~ ~ ~ ~V
Water Systam Identification Number
TYPE l]~ub~ic [] Individual
OF
SYSTEM: [] Other.
SAMPLE [] Distribution [] Special [:~Construction
IS:
[] Repeal for sample #
[] Recheck for sample #
[] Other
WATER [] River [~ake [] Welt
SOURCE:
Well depth Ch orine Residual
cETHOD & RESULTS:
tal Coliform Present
OIL Present
M.P.N. Total Coliform
(Colilert) E, CoIL
Membrane Filter/Fecal Coliform: 1st Dil /
Absent
/IOOML
/100ML
Avg ..... mi
Unsuitable For Analysis:
[] Form Income (see eocimled item)
E] Sample too old, nol received within 30 hours of collection
[] Excessive chlorine present in sample
[] Unsuitable container
[] Heavy, nco coliform bactaria/silt present, possibly obsculing and compromising fesi results ,
[] Quantity leo gmat to pMmil agitation
[] Quantity insufficient for analys~s (100 rnl minmum)
[] Other
A~aJyzecl by
Warm of satisfactory be~.srolOgical quality should be fre~ from Cokform Orgamsn'~
,J