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City of Lewisville Laboratory -CENTEI~,~h.2
Water Bacteriology
~~ Name of Water System County
Water System Identification Number:
;f17r~v'! _ r! f~~ ~~
dnt of ollection o ecte y Date Time ~l PM
/_ (MolDaylyr)
Billing NAME ~~ "` ~ ~~5; ~~lill,_,; ~ (9'%,
Reporting STREET •..D• ,'-/?}= 297
Address ciTV~lt ! `'• f1.+i'.-~ `-~ TExAS ~
r 7 / ~ 7 ip Code)
TELEPHONE (~~ ~7 ~ G ~ 7C°J L
TYPE OF Public ^Individual
SYSTEM: ^ Other
SAMPLE ^ Distribution ^ Special Construction
IS:
^ Repeat for sample #
^ Recheck for sample #
^ Other
WATER ^ River Lake ^ Well
SOURCE:
Well depth Chlorine Residual
fkMA~l ULTS: ....-
PresenUAbsent: Total Cdifonn Present / Absent
(Colilert) L Present sent
M.P.N. TotalColiform It00ML
(Colilert) E Cdi. It00ML
Membrane Filter/Fecal Coliform: 1st Dil. - /- ml 2nd _ I _ ml
Avg. _I _ ml
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
^ Fonn Incomplete (see attached item)
^ Sample too old, not received within 30 hours of collection
^ Excessive chlorine present in sample
^ Unsuitable container
^ Heavy, non-coliform bacterialsilt present, possibly obscuring and compromising test results
^ Quantity too great to permit agitatbn
^ Quantity insuffirrent for analysis (100 ml minimum)
^ Other
Analyzed by
Water of satisfactory quality should be free of Coliform Organisms
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City of Lewisville Laboratory ~,.
Water Bacteriolo~a+ ,
~ ~,
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- I~ ame Dt Water System County
i
~ i Water System Identification Number.
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t l.,f?
~; Pant of ~ ollection o~ yam- pate Time ~l PM
! ! (MolDaylyr) ~
g P' 1 .~
~ Billin NAME ` ~ ~"~ ' ~' : ~ ~; sy
~ , Reporting STREET ~f "'jam`
Address ciTr~r ~< ,~ u TExas ' f"~ ~ ~if ~~
~ ~'"~ / __ (Zip Code)
TELEPHONE (/ I~) .~jn ~ - ~,, ~ (r ~.
I
TYPE OF ~ Public ^ Individual
SYSTEM: ^ Other
i
I ~ SAMPLE ^ Distribution ^ Special ®'"~Construction
'~ IS: ,
^ Repeat for sample #
^ Recheck for sample # i
i
~
^ Other
~ I WATER ^ River ake
^ Well
SOURCE:
''
i. Well depth Chlorine Residual
,
i
ANALYTIC ULTS: ~-
~' resenUAbsen~ i Present Absent
rert) E:Cdi. Present
M.P.N. Total Coliform 1100ML
j (Colilert) E:Cdi. 1100ML
Membrane RlterlFecal ColAorm: 1st Dil. _ I _ ml 2nd _ I _, ml
Avg. ~~_ / _ ml
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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-wliform bacterialsih(,piesenl, possibly obscuring and compromising test results
^ Quantity too great to permit~agdatan
^ Quantity insuffident for ar~rlysis (100 ml minimum)
^ Other
~.
Analyzed by
Water of satisfactory quality should be free of ColAorm Organisms
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