ST9905DR-LR060110City of Lewisville Laboratory
Water Bacteriology
R~porling
Add;ess
TYF~ OF
SYSTEM:
SAMPLE
IS:
[] Repeat for sample #
WATER ~ River
SOURCE:
SULTS:
Present
Chlorine Residual ,,
/IOOML
UNSUITABLE FOR ANALYSIS: (This unsuitable ssmpla must bdmpl~ed within 24 hours.)
[] Fen11 Incomp~eta (s~e attached item)
[] Excessiw chlo~ne present in sample