WA9701-LR060216r., v` -'a�F i•Pas.�o: �d'�. err ,�. w. , p:..2... _ .e„ -r fc
Ci of Lewisville Laboratory 16
Water Bacteriology f
CL
f Name of water system _ County
C13
Water System Identification Number: -- `% —# b C) �� �, •
t Po
1 .its
ant o action o ee y Date Time (�d/ PM
1 r (Mo/Day/Yry
Billing NAME "! � v�''rS t° r c , t—A
Reporting STREE /O
Address CITY ��" ✓ �h TEXAS
(tip code)
TELEPHONE ( /� 1 / �/ ""- D ! .� G-
TYPE OF QPublic []Individual
SYSTEM: ❑ Other
..
SAMPLE ❑ Distribution ❑ Special ConaWction
IS:
t .. r
❑ Repeat for sample # { 1}
f ❑ Recheck for sample #
❑ Other
WATER ❑ River ® Lake ❑ Well m
SOURCE: c
Well depth Chlorine Residual
f CX7
LILTS: 4--+
Absent: Total Coliform Present t CT)
Present rlt
M.P.N. Total Coliform /100ML
t (Colilert) E:Coli. /100ML
1
Membrane FiIBerlFecal Colifwm: 1st DN. _ 1_ ml 2nd M1
N
Avg. -1- ml �
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
t ❑ Form Incomplete (see attached item)
r. ❑ Sample too old, not received within 30 hours of collection
❑ Excessive chlorine present in sample
❑ Unsuitable container
F ❑ Heavy non- colifonn bacteria/sift present, possibly obscuring and gga�rarnising test results 1:1 Quantity too great to permit agitation
❑ Quantty insufficient for analysis (100 ml minimum)
❑ Other
Analyzed by
Water of satisfactory quality should be free 0 Coliform Organisms