Wynnpage North 1-LR030820
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CITY Of LEWISVILLE LABORATORY - WATER BACTERIOLOGY
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I Name of Water System County ~ ~
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Water System 'dentifi7n Numb.r , ... 0:
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Poinl of Collection oIJecled By Date 11' <....,,-7 fA
(MoIDaylYr) ... ~ ..
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Billingl NAME < \f\ ..
Reporting STREET ~
Address; CITY TEXAS 7:;22 ~}
(//1. ) ')'t __ (Zip Code)
TELEPHON~ ~ Sr'55
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TYPE OF I:::J Public o Individual - :: 0 n
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o Other , M !!.
SYSTEM: " r-
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SAMPLE o Oisl1ibutiOl1 o Special EJ ConStrucliOl1 f i'
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o Repeat for sample # I;' Q
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o Recheck for sample # i'! e
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o Other ,
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WATER DRiver EJ Lake DWell '"
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SOURCE: a
Well depth Chlorine Residual -
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S & RESULTS: ll" i
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LPresenVAbsent Total Coliform=> "
Present ...
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(Colilert) ", '-'all. Present Absent I
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M.P.N. Total Coljfgrm I 100 foAL -3
0
( Colilerl) E, Coli. I 100ML ~
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___CotIann: IstDil I m/ 2nd I ml I
- - - - ...-"...
Avg. I ml
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8"
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UNSUITABLE FOR ANALYSIS: (Tllis unsuitable sample must be replaced witllin:24;llours.j
o Form Incomplete (see encircled item) _"'~
o Sample too old, not received within 30 hours of ccllection '..J
o Excessive chlorine present in sample \
B Unsuitable ccntainer ~_' ~
Heavy, non-coliform bacteria/silt present, possibly obscuring and compromising test results .A\l W ~
o Quantity too great to permit agitation /J ~.I ...-:; <t ~ ;
B ~a;tity insufficient for anaiysis (100 ml minimum) ~~"~ )) ~)
Analyzed by $~. i~ ~
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Blllingl NAME
Reporting STREET
Address: CITY
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TYPE OF
SYSTEM:
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SAMPLE
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WATER
SOURCE:
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Collected By
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Date
(MoIDaylYr)
Time
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(Zip COOe)
TELEPHONE (c;~' 2 )
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Public
o Individual
o Other
Construction
Distribution
D Repeat for sam pie #
o Recheck for sample #
o Other
o River Lake
DWell
Well depth
Chlorine Residual
ANALYTICAL METHOOS & RESUL T5:
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c:.:resenvAbsent
(Colilerl)
M.P.N.
(Colilert)
Total CoJifo~
E. Call.
Total Coliform
E. Call.
C 1\Dsent ../
Absent
100 foAL
100 ML
Present
Present
ml 2nll
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_Fo1IorIFecliColiIaln: 1slDil
Avg. m/
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UNSUITABLE FOR ANALYSIS: (TMs ullsuitable sample must be replaced witMn :!~ours.)
o Form Incomplete (see encircled item) l...) ~
o Sample too old. not received within 30 hours of coJJeclion ~....~
o Excessive chlorine present in sample
o Unsuitable ccntainer I A -
o Heavy, non-coliform bacteria/silt presen~ possibly obscuring and compromising test results ~ ~
o Quantity too great to permit agitation /).. / ~ ~ ~
8 ~a;tity insufficient for analysis (100 ml minimum) ~ 1'f!>::W L ~
Analyzed by 1f~ Q'" - /
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