Villages of CC P4-LR 921203W'~er System I.D. No. NAME OF WATER SYS1T:M
Daze
o SAMPLE IS WATER SOURCE
b_ TYPE OF SY:b~ (PuNic S~ems
o [~'Pubtlc r-~Da,[~y [] Distrib,~ [] Raw ['7 P~ver [] Lake
'~,Sc~ol [] Spoda~ Chbrine
Oy, memhip or ~
LABORATORY REPORT (0o net write
Wa,te~ of $~sfactor~ bacte~lo~cal quatity must be free from Celi~rm or(~uisms
Col'Lie r re O~'gallls~s ~./~1o_ t Found
[] FourzJ
[] Fecal coli~rm group
~ Repeat samples required
[] IJn~'~lY, e -- See
· UNSUITABLE FOR ANALYSIS - PLEASE
-I Sample mo o~. Sample no~ received
within 3~ h=urs of col',e~n
(See enci'cle~ item)
[] LeeXed i,~ ~'~nsit
ORr
[] Qua, ntity hsuffa;Jent for aaaNsis
(100 ~, re~iredl
possibly comp~oa'eising ~.t results
UNSU[TN~LE FOR ANALYSIS - PLEASE RESUBMIT
O HeaVy (:mlUbaciefia~ groedtt) presem,
Date disC~pan~y or ~ i~ ~i~ ~ ~ r~
(~ en~ ~1
2
Ouanlity ina
(10~ r~, ¢eq