WA9701-LR060308City of Lewisville Laboratory -
Water Bacteriology
e
r' Name of water system
or ��.�
Water Sys m Identification Number:
Poin of Cofti ColleGladB Date I ne t AM'I PM
n (MolDayffi)
Billing NAME f T ✓��. _tri'P r •
Reporting STREET
Address cay _'� y`'`�� TEXAS i 17 -rd �d
q , { (Zil Cade)
TELEPHONE
TYPE OF EV Public ❑lndivi&ml -
SYSTEM: ❑ Other
SAMPLE ❑ Distribution ❑ Special Construttlbn
❑ Repeat for sample #
❑ Recheck for sample #
' ❑ Other
WATER ❑ River Lake ❑ Well
SOURCE:
Wall depth Chlorine Residual
LTS:
Absent: Total Cdifam Present
(CoRlert) I. Present Absent
M.P.N. Total Coliform 1100ML
(Co ert) E:Coli. 1100ML
Membrane ft/Fecal Cdiform: 1st Dil. _ 1_ ml 2nd —1 ml
Avg. _!— ml
- 1 .
UNSUITABLE FOR ANALYSIS: (This unsullable sample must be replaced within 24 hours.)
❑ Form Incomplete (see attached item)
❑ Sample too old, not received within 30 tours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy, non- coliform bacteria/silt present, possibly obscuring and compromising test results
❑ Quantity too great to permit agitation
• ❑ Quantity insufficient for analysis (100 ml minimum)
❑ Other
r, Analyzed by
W ater of satisfactory quality should be free of Coldo6 Organisms
y
ar
�.7
Oka
w
Cb
1
t
;Jr7
COG°
C.t'1
fo
UNSUITABLE FOR ANALYSIS: (This unsullable sample must be replaced within 24 hours.)
❑ Form Incomplete (see attached item)
❑ Sample too old, not received within 30 tours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
❑ Heavy, non- coliform bacteria/silt present, possibly obscuring and compromising test results
❑ Quantity too great to permit agitation
• ❑ Quantity insufficient for analysis (100 ml minimum)
❑ Other
r, Analyzed by
W ater of satisfactory quality should be free of Coldo6 Organisms
y