Woodlands-LR 950807WA'i'ER BACTERIOLOGY Texas Department of Health
Form No. G-19 (Rev. 2/93) . Bureau of Laboratories
Date and .time Rec'd. Date
U t i ~ ,~ NAMEOFWATER~YSTEM
POINT OF COU.ECTION ~ }' COUNTY
SEND' IZl'~l"~'Zl'?' I~,~I/A/I.~I I~Z[JJ'g!pl£1c-P/l~L~. I I I I I I I II I
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tESULTS I 1-215151. 1?ls~l~qU~lyd tBZ.lvli"J I I I I III I I I I I ~
STREET ADDRESS (P.O. Box)
· ,-o: Iv.,
Date and :
SAMPLE IS WATER SOURCE
TYPE, OF SYSTEM (Pubac S'/stm~s O~)
[~ublic [] Dairy [] Distribution [] Raw [] River [] Lake
[] Individual [] Bottled [] Construct]on [] Repeat [] Well Well Depth
[] School [] Special Chlorine Residual
Ownemhip or other information:
LABORATORY REPORT~Do not write below)
Water of sa~factory~'t~?logica] q~al~ ~st be free from Coliform organisms
Coliform Organisms .,~fot Found ~
[] Found .
[] Total coliform group
'L [] Escherfchia coli
"'" [] Repeat samples required
[] Unsuita~e-- See below
UNSUFFABL~ FOR ANALYSIS - PLEASE RESUBMIT
[] Sampl~too old. Sample not received
within 30 houm of collection
[] Date discrepancy or form incomplete
(See encircled item}
[] Leaked in transit
[] Other
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy (silt/bacterial growth) present,
possibly compromising test results
WATER BAC'~ =RIOLOGY Texas Department of Heat~
Form No. G-19 (Rev. 2/93) Bureau of Laborafodes
Date and 'lime Recd. Date'
Sample NO. ;~_ ~, ~epor~ed
ae,~ ma~ abo~e this line -- Please'ptirlt?~?, I~., nt Pe~ or t~.
Submiit~.D;~ 1't J I I I I · ..
NAME ·
STREET ADDRESS (P.O. BOx) '
CITYI / ZIP CODE
Date and
'fimeof
I, lJ lL
SAMPLE IS WATER SOURCE
TYPE OF SYSTEM (Pubac Systems On~y)
[] Public [] Dairy [] Distribu~on [] Raw [] River [] Lake
[] Individual [] Bottled [] Conai]'uclJon [] Repeat [] Well Well Depth
[] School [] Special Chlorine Residual
Ownemhip or other information:
LABORATORY REPOI~(Do not write below)
Water of sa~s~-ctory,~ologica~al'F~J~ust be free ~om Coliform organisms
Coliform Organlems ..,~Not Found ~
[] Found
[] Total coliform Qroup
'". [] Eschedchia coli
'~ [] Repeat samples required
[] Unsuitable -- See below
UNSUITABLE FOR ANALYSIS - pLEASE RESUBMIT
[] 8ample"l°° old. Sample not received
wi~in 30 hours of collection
[] Date discrepancy or form incomplete
(See encircled item)
[] Leaked in tan,sit
[] Other
[] Quantity insufficient for analysis
(100 mi. required)
[] Heavy (silt/bacterial growth) present.
pess~y compromising test results
~. SEHD
~0:
~ ~s
~u~ ~ O~ ~ Redat ~ Wett Wetl Oep~
~ tndi~U~ ~ ~ ~ ~on ChtOdne R~du~
~ ~/~ oua~ust
~ R~at samptes
~ Unsure ~ See
..... td S~e ~t r~
~ ~;; ~ ~t~
(See e~~ Rem)