Wynnpage North 1-LR030529
CITY OF LEWISUILLE LABORATORY - WATER BACTERIOLOGY
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Time &, PM
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Dale
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TELEPHONE PIll.) 2L..J:, _ 545? (ZipCodeI
Blllingl NAME
Reporting STREET
Address: CITY
TYPE OF
SYSTEM:
Individual
D Other
Construction
SAMPLE
IS:
o Distribution
o Repeat for sample #
o Rechll"Jc for sample #
DOttIer
WATER 0 River
SOURCE:
Lake 0 Well
Well depth
Chlorine Residual
S & RESULTS:
Total Coliform Present
E. Coli. Present
Total Coliform
E. Coli.
~
Absent
I looML
I 100 ML
_FiUIIlFec;lCalibm: 1st Oil
mI 2nd
mJ
Avg. mI
-~-
UNSUITABLE FOR ANALYSIS: (This unsuitable sample /11l/st be replaced witllin 24 11~iiJ:!.)
......-J
o Form Incomplete (see encirded item)
D Sample too old, not received within 30 hours of collection
o Excessive chlorine present in sample
o Unsuitable contalner
o Heavy, non-coliform bactetialsilt presen~ possibly obscuring and compromising test results
o Quantity too great to permll agitation
D Quantity insufficient for analysis (100 ml minimum)
o Other
Analyzed by
kvJ
Water of satisfactory bacteriological quality should be free from Coliform Organisms.
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