Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Hard 8 BBQ-LR061006
10 06 2006 11 28 8174780443 JACk SON CONSTPI_U=TION '!n. "F"";m y 1Y rsgrf y` rK TARRANT COUNTY PUBLIC HEALTH ,r Bacteriology 1101 S Main St., Ft. Worth, TX 76104 t. 1 USEPA Lab No 01471 (817)321 -4750 d Lao Date and Time Received Data and Time Reported SAMPLE IbENT/FICATION [Nn_ PUBLIC WATER SYSTEM 10 COUNTY Seven drpas (REGIUIRED) PUBLIC WATER SYSTEM NAME Send Name Semple Street Address O teflime Collected: Sample Site: Sampler Name/Phone: SYSTEM TYPE ©P biic [l Private/Individual DOther_ Ra885tIt* CI State Zi To To be checked by *Semple Collector- El Sbmpre too ord. Not received widen 10 our or oollnctlon E pOuentity Insufficient for analysis (10D nit.. rn rmd) O FOrm Incomprote 1 data discrepancy. CIRCLE errors) QOlher reason DESCRIBE DISINFECTANT RESIDUAL (Mandatory) (Sample should not be collected If no residual Is present) C0wnerIPWS DOperetor SAMPLE SITE COLLECTION DATE and TIME fi car Mhnrn nay C5 Sys' Time) of Day 4 //a r'otl10r f Ls�'` am Pm rnsMpf0n; not.rnmpfr. rJM number) r -7 SAMPLE TYPE (ode! tmemo On 0Distribution LjRaW wart onatn)etion ❑Spe�lal R epeat for sample QOtner' mg/L. LABORATORY REPORT (DO Not Write Below) Test Method Used: Colirbrt PIA EICollrort MPN COLIFORM ORGAN! M Total coliform RINOT Found Found Escherlchia coif aNOT Found []Found /loOml ClUnsulttiblet for anklysis {see below) Anelyat Initrale: 11 SAMPLE UNSUITABLE FOR ANALYSIS unsuitable sample must be replaced dlfhrn 2e nrs3 Submit to TCEO1Publlc Drinking Water MC.165. PO BOX 13017, Auatln, TX 713717 r rat Poskhra tv 612 258 atiee H-220 GPC -2190 Rev 06-04 COPIS' CUSTOMER. LABORATORY, TCEQ WATER SOURCE 0 Groundwater 11) Suliace water (Lake, River) J Free Chlorine Chlortmine (Total ChIDr ne) Number of samples Collected on this date l h [JMW rjMembrano Filtration D tenvy SILT I BACTERIA !TURBIDITY PRESENT (circle) El Sample leaked In transit Excessive Chlorine residual PAGE 02 02