Villages of CC P4-LR 921215Wa.~er System I.D. NO. NAME OF WAI~R SYST'~M
~u~
~OF ~E~ ~
s~.o.~. ! I I ~ I L I I
ZIP C~E
LA ~qATI:~Y ~ (Oe, not ~ be~
Wat~ of satisfactory I:mcteddogLcal qualily m~st be Irae trom C~r~m c~ganisms
[] Total colitorm group
[] Fecal oolifo~m group
'~ Unsuita~e -- See ioelow ._
UNSUITABLE FOR ANALYS1S - PLEASE RESUBMIT
[] Sample to~ •icL Sa~le not re~ived
within 30 boa= of ceaLeclion
:-I Data discr~ o~ tom~ inoomptate
(See encadad i~e~)
0 Leaked In tmmit
[] Quar~ty imufficier, t 1or anaJ. y.~s
(100 mi. ~ired)
[] Heavy (stlFoacteda gm,,dh) p~esem,
~ _*t~_ ~bly cema•raising tast msuEs
~ I.D. ~- ~E ~ WA~R ~
su~.~ I I I 1 I I I
NAME
water of sat~acto~ bacledological quality must be lree ~rom Col~rm organisms
Collfon~ Organisms "~ Fou~ ~ ~
[] To{al co, if•tm groIRo ~', ~,
[] FecaJ coliform group
[] Rer~at samples requ~ed
UNSUITABLE FOR ANALYSIS - PLEASE RESUBMIT
0 Sampte too ~L Sae~e not ,ecek'ad
aal~-~n 30 beurs of o011e~e
[] Da~ discrepancy or form incomplete
CSae e~ci~cled
[] O~er
0 QuarEey imufficient for analysis
(t00 mi. raquire6)
[] ~ (~Vg/3~cf~:J~i gll:~th) ~'e~tr
posst0ly c~mpromlr, ing mst results
SAMPLE
TYPE OF SYS'TE~
WA'ITr..R sOURCE
i~C, onstn~c~ [] Repeat [] Well Well Depth~
~----~----- '~EPORT (Do not wr~e~ .
/ ~ Found ~ ~ ~
~ Un~-- ~e be~W
UNSU~LE FOR ~YSIS i p~E RESU~IT
~ Da~, discrepancy or fom~.inco'n~,lete
(See endrde~
[] Lea~,ed in ~.a~sit
Ovmem~p o; otb, er info~a~on:
lABORATORY R~PORI' (Do sot ~ ~
W~r ot sa~ bacteriolo~c~ qua&'y ~e.st be free ~'o~n Coliform arganisats
[2 io~1CO[fO~ ~.ml~ "~ .~
E~ Feag ~ group
~ Un~e-- See ~ ~
UNSULTAI~.E FOR ANALYSIS- PLEASE RESUBMIT
[] ~mple too old. ~ample not received
wi~r, 30 hout~ of col~clJon
:-1 Date discrepancy or tomt incom~ete
Gee encirded item)
~ LeaY, ed in eans~
[] Quan'~ insuffidmt ~ atatysis
(100 ml_ ~quired)
FI Heavy [saroac~-~al grow~) present,
~ _..~_ Chly ~mpmm~sing ~ results
COLL.EC'EO t,Y
'~4:llecUon ~ DAY
SAMPLE IS WA [ =. SOURCE
0.~---"-.;2 or ot~m idoraa~,:
t. AB~a~TORY REPORT (Do
~ F~und
FI Total co]ilc~a group
[] F_ _~c~ ~ group
:. .. , . ~ :0~~
[] p~ sar~e~
g
UNSUITABLE FOR ANALYSIS- PLEASE RESUBMIT
[] Sample too Nd. Sampta not received
,affitin 30 hou~ of
~ Date diso'el:~-'Y o~ fomt i;~cx~mplete
iSee endrc~d i~em)
[] Leaked in
[] ~ insuf~ient f~r anaJysis
(1~ mL raqui'e~
possibly compmmL~g te~ ~s~s
~14 ~ 094~
1~?~1/9~ 14:18 CITY OF COPP~LL 001
'd
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