ST9401WA-LR 961003CITY OF LEWISVILLE LABORATOJ - WATER BACTERIOLOGY
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AM/RM
ate Time
(Mo /Day /Yr)
��EX`AS-Z d�b 2 '
ing STREET
Address:
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TELEPHONE(q 71 ) -
Water System Identification Number
TYPE [.}em llic ❑ Individual
OF ^rr... ❑ Othef
SAMPLE ❑ Distribution ❑ Special onstruction
IS Repeat for sample #
❑ Recheck for sample #
❑ Other
WATER ❑ River Lake ❑ Well
SOURCE Well depth Chlorine Residual
ANALYTICA ME T H OD & RESULTS
Present Absent
Present/Abs Total C oliform nt
Fecal Coliform Present
M.PN. TotalColiiorm 1100ML
100ML
Fecal Coliform
Membrane Filter /Fecal Coliform. 1 st Dil. _ j _ ml 2nd --/-ml
Avg.
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Unsuitable For Analysis.
❑ Form Incomplete (see encircled item)
❑ Sample too old, not received within 30 hours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy non coliforrn bacteria/sih present, possibly obscuring and compromising test results
❑ Quantity too great to permit agitation
❑ Quantity insufficient for analysis (100 ml minmum)
❑ Other
Analyzed by t '
Water of satisfactory badsrological quality shUd be free from Coliform Organisms.
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Unsuitable For Analysis.
❑ Form Incomplete (see encircled item)
❑ Sample too old, not received within 30 hours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy non coliforrn bacteria/sih present, possibly obscuring and compromising test results
❑ Quantity too great to permit agitation
❑ Quantity insufficient for analysis (100 ml minmum)
❑ Other
Analyzed by t '
Water of satisfactory badsrological quality shUd be free from Coliform Organisms.
CITY OF LEWISVILLE LABORATORY - WATER BACTERIOLOGY
Water System Identification Number
TYPE ublfc
�'1�' El Individual
OF ❑ Other
SYSTEM
SAMPLE ❑ Distribution ❑ Special ns ruction
IS l Repeat for sample # _�4 br �
❑ Recheck for sample #
❑ Other
WATER
❑ River gLak.
❑ Well
SOURCE
Nfime
of Water System
County
�
R6
ANALYTICAL METHOD & RESULTS
14 f 6
Point of Collection
�
/00 h AM/PM
LPN Time
�Present/Absent
Total Colitorm )
Present Absen
(Mo/ ay /Yr)
Billing/
NAME y
.0 4
N S
Reporting
Address:
STREET
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CITY L
/2 V / ri S
TEXAS 7 r O
TENEPHONE( T�2 ) 7 7 06 3( code)
Water System Identification Number
TYPE ublfc
�'1�' El Individual
OF ❑ Other
SYSTEM
SAMPLE ❑ Distribution ❑ Special ns ruction
IS l Repeat for sample # _�4 br �
❑ Recheck for sample #
❑ Other
WATER
❑ River gLak.
❑ Well
SOURCE
m
c
Well depth
Chlorine Residual
ANALYTICAL METHOD & RESULTS
A �
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�Present/Absent
Total Colitorm )
Present Absen
Fecal Co 1 orm
Present A sent
M.PN
Total Coliform
/100ML
r
Fecal Colitorm
/100ML
Membrane Filter /Fecal Colitorm: 1st Dil. / ml 2nd _
Av - / - -ml
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Unsuitable For Analysis g Cti
roj
❑ Form Incomplete (see encircled item) � U U� 1 t
El sample too old, not received within 30 hostZE .
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy non coliform badeha/silt present, possibly obscuring and compromising test results
❑ Quantity too great to permit agitation
❑ Quantity insufficient for analysis (100 ml minmum)
❑ Other
Analyzed by ':�' , )C,
Water of satisfactory bac'erological quality shot' d be free from Co6form Organfsrm.
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