ST9902-LR060615City. of Wwisville Laboratory
i Water Bacteriology
C - "n P P;
Name of Water System County
Water System Identification Number:
ndti lA jwfoyal 4
Point of Colletctidh Colltaj a' - �Date — r 2 i�na� O PM
(Mo/DayNr)
Billing NAME YldV
Reporting STREET t 1 G C J 1 L '
Address ci 't Y In r TEXA4
(Zip Code)
TELEPHONE (PC.)
TYPE OF [3 Public ❑ Individual
SYSTEM: ❑ Other
SAMPLE ❑ Distribution ❑ speci [3k c ons t r o c ti on
IS:
❑ Repeat for sample #
❑ Recheck for sample #
❑ Other
WATER
Cn
❑ Well
SOURCE:
Well depth
Chlorine Residual
AN
�METH�QQ& RESULTS:
_��D
9?MW-98hfiML—
sent
L L
Absent
(Co1w)
:Col'
.Col P r e sen t
e 30
Total Coliform
/100ML
(Calflert)
E:Coli.
/100ML
M&bMwFilW/F9ca1Co11Wm: ls(Dil.
M1 2nd fni
t--4
C. r1
CL
7w
Water System Identification Number:
ndti lA jwfoyal 4
Point of Colletctidh Colltaj a' - �Date — r 2 i�na� O PM
(Mo/DayNr)
Billing NAME YldV
Reporting STREET t 1 G C J 1 L '
Address ci 't Y In r TEXA4
(Zip Code)
TELEPHONE (PC.)
TYPE OF [3 Public ❑ Individual
SYSTEM: ❑ Other
SAMPLE ❑ Distribution ❑ speci [3k c ons t r o c ti on
IS:
❑ Repeat for sample #
I
I
Avg. —I ml
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
❑ Form Incomplete (see attached item)
❑ Sample too old, not received within 30 hours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy, non-Wfform bacteria/silt present, possibly obscuring and compromising test results
1:1 Quantity too great to permit agitation
❑ Quantity insufficient for analysis (100 ml minimum)
❑ Other
Analyzed by
Water of satisfactory quality should be free of doii(orm organisms
❑ Recheck for sample #
❑ Other
WATER
❑ River Cake
❑ Well
SOURCE:
Well depth
Chlorine Residual
AN
�METH�QQ& RESULTS:
_��D
9?MW-98hfiML—
sent
L L
Absent
(Co1w)
:Col'
.Col P r e sen t
M.P.N.
Total Coliform
/100ML
(Calflert)
E:Coli.
/100ML
M&bMwFilW/F9ca1Co11Wm: ls(Dil.
M1 2nd fni
I
I
Avg. —I ml
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
❑ Form Incomplete (see attached item)
❑ Sample too old, not received within 30 hours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy, non-Wfform bacteria/silt present, possibly obscuring and compromising test results
1:1 Quantity too great to permit agitation
❑ Quantity insufficient for analysis (100 ml minimum)
❑ Other
Analyzed by
Water of satisfactory quality should be free of doii(orm organisms