Denton Tap 1A-LR051219City of Lewisviile Laboratory
Water Bacteriology
Address ClW ~ TE~ ~ ~ 5~
TYPE OF ~'~b{ic [] Individual
SYSTEM: [] O~ner
SAMPLE [] Distobo{~n [] Spedal ~ Co~s[mct~n
IS:
[] Repeat lor sample #
[] Recheck for sample #
WATER [] River [~'L~ke [] Well
SOURCE:
Well depth . Chtodne Residual
UNSUITABLE FOR ANALYSIS: (This unsudable sample must be replaced within 24 hours,)
[] Form Incompto{e (see a~ached ~m)
[] Sample too old, no{ received within 30 h~urs et collection
[] Excessive caloone Fese~t in sample
[] Unsuitable container
[] Heavy, r~n-col~fon~ bacteda~allt i~-esent, possibly o~scu~ng and ca'~3mmising test results