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TARRANT COUNTY PUBLIC HEALTH LABORATORY
WATER CT�RIOLOGY 1800 University Dr., Ft Worth Tx 76197
Lab,Nq. ¢8010 1811)871.7245
Date and R
Sample No. Report L
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NAME df WATER SYSTEM
No . >•a�t
NAME
SEND . 5 5
RESULTS STREET ADDRES - (P.C. Box)
TO: A � Hf/ r L� TX 6 06 3
CITY (Zip code)
/7 — -i'7 7- /
PHONE✓< COUNTY
Date grid "'
UNSUITABLE
Time of
❑
Collection
Month 'Day
TYPE OF SYSTEM
comic
❑Dairy
❑Individual
]Bottled
❑School
❑Vended
Additional Informations
Year TIME
SAMPLE IS
❑Distribution ❑Raw
Oferistruction ❑Repeat
❑GlycollSweetlChill Water
❑ 0ther
AMIPM Collected By
WATER SOURCE
❑River ❑Lake
❑Well
Well Depth
Chlorine Residual
TARRANT COUN UBLIC HEALTH LABORATORY
WATER CTERIOLOGY 1600 University Dr., Ft Worth, TX 1.724
'13 1 4b Imo J4 - 90 (f1Af71.7245
Date aad Tana Recd. (�
Sample No. 00 f � 7 26 - 97 r, ReporfEd� � • 2:
Do Not Mark Above This Una - 44"se Print Below with BALLPOINT PER OR TYPENRNTEIL
NAME OFVIATER SYSTEM
Lm 7 /8 / G6c/C F �!
PONT OF COLLECTION Water System I.D. me.
HST
NAME
SEND
RESULTS STREET ADDRESS (P.O. Box)
TO: TX
,pTy IZp Code)
/7 a'7-
PHONES COUNTY
Date a nd 1 z 1 1 Q � 1 � � S
Time of L2 I I/ I I / I C I I�
Collection Month Day Year TIME
TYPE OF SYSTEM
C Public ❑Dairy
❑Individual ]Bottled
❑School ❑Vended
MMO•MUG
PresencelAbsence
Coliform Organisms
Not
Found
Additional Information:
LABORATORY REPORT I Do no write below) TECH
. _ , - ,' :rM "fAB01tAT11RYREPb aowri 6plowf -._,
MMO•AAUG
PresenoelAbeence
Oallform Organisms
)6 Not
p Found
❑ Total Coliform group
❑ Escherkma soli
❑ Repeat samples required
❑ Unsuitable, See below
Membrane filtration (MF)
Coliform Otybaisrns _i�t
❑-Not Found
❑ Found
Total Coliforml100 ml
- E.co117100 ml
Fecal Coliforms1100 ml
.._ , _ .
wnwv -p�uu Most Probable Number (MPN)
Coliform Organisms
Cj Not Fodril.
❑ Found
Total
Coliform: MPN1100m1
E.colF , MPN110Om1
❑ Uristiitable See Nelow '. + =—
SAMPLE IS
❑Distribrrtion ❑Raw
[Beditstntction ❑Repeat
0GlycollSweet1Chiu water
❑0ther
Membrane Filtration (MF)
Coliform Organisms
❑ Not Found
❑ Found
�J I I 1
AMIPM Collected
WATER SOURCE
❑River ❑Lake
❑Well
Well Depth
Chlorine Residual
MMO -MUG
Most Probable Number (MPN)
Coliform Organisms
❑ Not Found
p Found
❑ Total Coliform grow Total Coliform1100 ml Total
❑ Escherkbis cofi E.ON100 rid Coliform: MPNI100m1
❑ Repeat samples required Fecal Coliforms1100 ml E.coli: MPNI1100ml
❑ Unsuitable -- See below ❑ Unsuitable -- See below ❑ Unsuitable -- See below
UNSUITABLE
FOR ANALYSIS - PLEASE RESUBMIT
❑
y
Sample too old. Sample not received
❑
Quantity insufficient for analysis
within 30 hours of collection
(100 m1. required)
❑
Date discrepancy or form incomplete
❑
Heavy (siltibacterial growth) present.
(See encircled item)
possibly compromising test results
❑
Leaked in trorusit
❑
Sanpte received on Friday
❑
Quantity too greet to permit agitation
p
Other
❑
Excessive chlorine residual: not.
SAMPLE IS
❑Distribrrtion ❑Raw
[Beditstntction ❑Repeat
0GlycollSweet1Chiu water
❑0ther
Membrane Filtration (MF)
Coliform Organisms
❑ Not Found
❑ Found
�J I I 1
AMIPM Collected
WATER SOURCE
❑River ❑Lake
❑Well
Well Depth
Chlorine Residual
MMO -MUG
Most Probable Number (MPN)
Coliform Organisms
❑ Not Found
p Found
❑ Total Coliform grow Total Coliform1100 ml Total
❑ Escherkbis cofi E.ON100 rid Coliform: MPNI100m1
❑ Repeat samples required Fecal Coliforms1100 ml E.coli: MPNI1100ml
❑ Unsuitable -- See below ❑ Unsuitable -- See below ❑ Unsuitable -- See below
❑ Excessive chlorine residuet m 1.
H -220 GPC -2190
_ UNSUITABLE
FOR ANALYSIS- PLEASE RESUBMIT
❑
Sample too old. Sample not received
❑
Quantity insufficient for analysis
within 30 hours of collection
(100 od. required)
❑
Date discrepanc or foam incomplete
❑
Heavy (sMacterial growth) present,
(See encircled item)
possibly compromising test results
❑
Leaked in transit
❑
Sample received on Friday
❑
Quantity too great to permit agiurtm
p
Other
❑ Excessive chlorine residuet m 1.
H -220 GPC -2190