Belt Line Trade-LR060419
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. be replaced within 24 hours.)
UNSUITABLE FOR ANALYSIS. (This unsuitable sample mu~ _~.
O complete (see attached item)
Fonn In 'ved within 30 hours of colleclion
o Sample too old, not reC81 .
o Excessive chlorine present In sample
o Unsuitable container .. nt possibly obscuring and compromiSing test results
o Heavy, non-colifonn bactena/sl.1t prese ,
o Quantity too greatto pelll1lt agitatIOn ") " _
o Quantity insulflCient for analysis (100 ml minimum
o Other
....
,\ "", -!.:;!/. 4 ,)
\. , 'I County
~ .~
\ Name of Water System
Water System I~lifica~on ~mber: '---" '1-; q::..~..Ju ,.-"
I . i IvItJlI ~IVI: ~ Date. Time ~)PM
o Poytt of Collection y (MoJDaylYr)
Bf!.lfLJ(v~ Kr)_ -D4L. ..... _
NAME 1,..) _
Billing
:5' <-j D (() ,.-?')(y)( f( (
Reporting STREET
{- V h \!../f i{ \ TEXAS _
Address CITY J
7t ()q)
(Zip Code)
TELEPHONE
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TYPE OF
SYSTEM:
SAMPLE
IS:
:sf Public
o Other
o Individual
o Distribution
o Special
I
Oil Consll\lclion
o Repeat for sample #
o Recheck for sample #
o Other
,
_J
WATER
SOURCE.
DRiver
o Well
Chlorine Residual .
.......,.....'
~Lake
Well depth
I~lll u~ & RE~TS:
Cfi~nt ~:~aifoon ~::~:
M.P.N. Total CoIlfoon
[(CoIilert) E:CoIl.
, ml 2nd _1_ ml
f Membrane Fill8rfFecal CoIiIonn: 151 011. 1_
~ Avg. _1_ ml
I
-~
/1ooML
/100ML
v
Analyzed by.~ Coliform Organisms
Water of satisfactory quality should- be free of
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