ST9401WA-LR 960918CITY GF LEWISVILLE LABORATORY - WATER BACTERIOLOGY I
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Name of Water Sysst m County
i
Point of Collection Collected By Date time
-c (kWDay/Yr)
Billing/ NAME S
Address: Add s:: STREET '?q OO • k,4, /P�✓ (-' t.eJ a� �
CITY "; A 4 TEXAS 77 <s
TELEPHONE( Iii/ ) �, 7 ?)AC
Water System Identification Number
TYPE
OF (9 Public ❑Individual
SYSTEM El Other
SAMPLE ❑ Distribution ❑ Special VQonstruction
IS
❑ Repeat for sample #
❑ Recheck for sample #
❑ Other
WATER ❑ River O' Lake ❑ Well
SOURCE
Well depth Chlorine Residual
ANALYTICAL MET HOD & RESULTS
Pr esent/Absent: Tot al Coliform Present
- At b
Fecal Coliform Present
A sent
M.P.N. Total Coliform
1100ML
Fecal Coliform
/100ML
Membrane Filter /Fecal Coliform: 1st Dil. ! mf 2nd - - / - ml
Avg. _ /__ ml
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 coliform bacteria/sill 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 satsfactory bac:erological qually sh d be free from Conform 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 coliform bacteria/sill 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 satsfactory bac:erological qually sh d be free from Conform Organisms.
0
0
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