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TARRANT COUNTY PUBLIC HEALTH LABORATORY
WATER BA T ~~ Gam- f x+ r ,?~OUniversityOr., Fc--Worth, TX 16107
1 y _ Lab No- 46010 J (817)871-7245
1 r .
Date and Time Recd. ~ t '~` : ~ ; t:
Sample No. Reported
Do Nat fMark Ahove This Line -----Please Print Below wit AL
~~ 1-j f ~ sG~ ~G ~ ~ O
NAME OF WATER SYSTEM
LoT // ~Lo c f ~r~3
POINT OF COLLECTION
.N~, G
UNSUITABLE FOR ANALYSIS--PLEASE RESUBMIT
' ^ Sample too old. Sample not received ^ Quantity insufficient for analysis
within 30 hours of collection (100 ml- required)
^ Date discrepancy or form incomplete ^ Heavy (siltlbacterial growth) present,
ISee encircled item) possibly compromising test results
^ Leaked in transit ^ Sample received on Friday
^ Quantity too great to permit agitation ^ Other _ __
{ ^ Total Coliform group Total Coliform1100 ml Total
^ Escherichia coli f.cold 100 ml Coliform: MPNIl00ml
^Repeat samples required Fecal Coliforms1100 ml f.co/% MPNIl00ml
^ Unsuitable ~~ See below ^ Unsuitable -- See below ^ Unsuitable •• See below
- NAME
SEND 2 /O S ~~y ST '~~,F ,
RESULTS STREETADDRESS (P.O. Boxl
ro: / f~ L/S f ~c G~ ' ~ Tx ~'~0~3
CITY IZp Code)
~~7 - x{,77 /5i/y ~`>;~J-~.~. c, ~ --
PHONEar COUNTY
Date and ~ ~ C 4 1.,,~ ~ v
Time of
Collection 6lnnth Day Year TIME AMIPM Collected By
TYPE OF SYSTEM SAMPIE IS WATER SOURCE
Public ^Dairy ^Distribulion ^Raw ^River ^lake
^Individual ^Bottled onstruction ^Repeat ^Well
^School ^Vended ^GlycollSweetlChill Water Well Depth
^Other Chlorine Residual
Additional Information:
LABORATORY REPORT IOo no write below) TECH
MMO•MUG Membrane Filtration (MFI MMO•MUG
esence~A6sence Most Probable Number (MPN)
Coli m Orgam s
F
d Coliform Organisms
t Fo
nd
^ N Coliform Organisms
^ Not Found
oun
Not
^ found u
o
Q Found Q Found
^ Excessive chlorine residual: _ _mgll
H-219 CPC-2190
PEN OR TYPEWRITER:
Water System I.D. No.
~u5~ ~'~~
N
4
r~~~~
{lip Cadet
1 ~~ ~ / fir-
Year -TIME .
` AMIPM Collected By
SAMPLE IS WATER SOURCE -
^Distribution ^Raw ^River ^Lake
Construction ^Repeat ^Well
^GlycollSweetlChill Water Well Oepth -
^Other Chloritte Residual
r° -LABORATORY REPORT (Do no write below) TECH ~~
MMO MUG Membrane Filtration IMFl MMO•MUG
PresencelAtisence Most Probable Number (MPN) ``
` Col' rm Organi Coliform Organisms Coliform Organisms _
a ~ot Found"'/ ^ Nat Found -~ - - - ;; ^ Nat Fottnd ,. -
^ Found ^ found %~ ^ Found ~~
^ Total Coliform group Total Coliformlt00~m1 Total '
^ Escherichia tali f.co[d 100 ml Coliform: MPN1100m1 '
s - - __ _
Q Repeat samples required ~ `FecaFCo(iformst100-tN• ' - '-r o~~- ~ = =MPI'tiTOUrr~-~ `
^ Unsuitable -- See below ^ Unsuitable -- See below ^ Unsuitable •• See below
UNSUITABLE FOR ANALYSIS••PLEASE AESUBMIT
^ .Sample too old. Sample not received ^ Ouantity,insufficient for analysis
within 30 hours of collection _ ~x .. (T00 int.-iequiredl _ '-
i
^ Oate discrepancy or form incomplete ^ Heavy Isiltlbacterial growth) present.
{See encircleQi[em! -'° possibly compromising test results -
^ Leaked in transit ,
- ;~] Sample received od Fiiday
^ Quantity too great to permit agitatidn ' ^ Other
^ Excessive chlorine residual: ___ _mgll «-
• h-219 GPC-2194
_`
~"' ~ ~[ ~
i NAME Of WATERSYS EM -
. POINT Ilf CO1lEC~T,ION _ .., -,1~t` : _ ~ _ . - .Watar±Systern LD Na:;~=,,
~._ ~ _ NAME / ~,., _ _ ..
E WATER BACT iL • ~ .~- ... No. .~ _ - s»-a~.~g~zds
_ _ __ __ _ - _ .~ ,c
Oate and Time Recd. Dade . - . -
p Sample No. t R~~ a ` . - :
~,~ Do Nat Mark Above This Line ~-•••Please Print Below with BAL OINT3,P~JIt f!l~TYPEWRITER:
,. .. _
TARRANT COUNTY PUBLIC HEALTH ~-ABQRATORY _ ..
~16f10 tfn'iversrty tlr~F ~th, TX 16f 07
---
SEND Z . f ~ 5 ~ -~ .~__~_.
RESULTS STREE .ADDRESS IP.O. Boxl
T0: - Q1-/'1'S ~i ~ ~~ TX
" CAVITY ~/ _ . -
PH NEAP 7•, y ~/~/y couNTr Y-~-
Additional Information:
Oateand I - i „(I (,.~
'
Time of I'J I uj}
1
Collection hlonth - Oay
TYPE OF SYSTEM
^Puhlic ^ Dairy
^Individual ^Bottled
^School ^Vended