ST9401WA-LR 961016CITY OF LEWISVILLE LABORATO$Y - WATER BACTERIOLOGY
❑ Recheck for sample #
❑ Other
WATER ❑ River ake ❑ Well
SOURCE
Well depth Chlorine Residual
ANALYTICAL METHOD & RESULTS
Present/Ab Total o I orm` Present Absen
— —'--- Fecal Loornumn Present nt
M.P.N. Total Coliform 1100ML
Fecal Coliform /100ML
Membrane Filter /Fecal Coliform: 1 st Dil. / mt 2nd - -/ ml
Avg. ___ml
Unsuitable For Analysis. w
❑ Form Incomplete (see encircled item)
❑ Sample too old, not received within 30 hours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy non coliform bacterialsilt present, possibly obscuring and compromising test results
❑ Quantity too great to permit agitation
❑ Quantity insufficient for analysis (100 ml minmum)
❑ Other �
Analyzed by
Water of satisfactory bac:erological quality show 4le free from Cohlorm Organises.
ame of Water System
County
be>uTor, - rAp
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QI
T
Point of Collection Collec d By
f
D Time
o /Day /Yr)
Billing/ NAM c 7 S
Reporting STREET
Address: _ _
CITY
TEXAS 75 G 2
TELEPHONE '� 2 2 S 7 C: code)
System Identification Number
TYPE lCf"Public ❑ Individual
OF
SYSTEM- El Other
SAMPLE ❑ Distribution ❑ Special
E!!<nstruction
IS
❑ Repeat for sample #
❑ Recheck for sample #
❑ Other
WATER ❑ River ake ❑ Well
SOURCE
Well depth Chlorine Residual
ANALYTICAL METHOD & RESULTS
Present/Ab Total o I orm` Present Absen
— —'--- Fecal Loornumn Present nt
M.P.N. Total Coliform 1100ML
Fecal Coliform /100ML
Membrane Filter /Fecal Coliform: 1 st Dil. / mt 2nd - -/ ml
Avg. ___ml
Unsuitable For Analysis. w
❑ Form Incomplete (see encircled item)
❑ Sample too old, not received within 30 hours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy non coliform bacterialsilt present, possibly obscuring and compromising test results
❑ Quantity too great to permit agitation
❑ Quantity insufficient for analysis (100 ml minmum)
❑ Other �
Analyzed by
Water of satisfactory bac:erological quality show 4le free from Cohlorm Organises.
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