Victron-LR070219�cteriolo aNTY PUBLIC HEALTH
Water
gy 1101 S. Main St., P" 'orth, TX 76104
USEPA Lab No. 014 (817)3214750
Lab Specimen 6 Date and Time Received Dab and Time Reported
SAMPLE IDEAMFXAT1ON L f, F- - i i i 'Irl 4 a
PUBLIC WATER SYSTEM ID COUNTY
seven d aft (REQUatED)
PUBLIC WATER SYSTEM NAME [ c�.Q 2 4
me
Sand Na - Z 77 n h cy r <� �/� ^� --4 l J c
Sample Street Address
a.x Rends City, State Zip L2 / l/ / 7 7 /•• -- ��s y � S ' i &C
o. Phone
To be Cheretud by maple Consclo
❑Ownsr/PWS oaerabr ❑ 011tsr
/)} SMPLE 5/7E/ COLLECIM DATE and TIME
Da1NThtw CON@Ctm: 1 Cy 0 �) 0 ❑
Abrdb Dey year ) rNmsaDsy am pin
Sample SRO: iC � 2W, / l A) "' /
I ch —W6on; nor sample ale mwnber)
Sampler NrnelPlwne: _.-I / V - 'I r 7 S -
TARRANT COUNTY PUBLIC HEALTH
W ter
PlicterioiogY F' -1+01 s. Mai6,%. t' `fi rth; TK76104
USEPA Lab No. 014.,_/ (817)3214750
Lab Specbrran s tt Date and Time Received Dab arW Time Reported
PtIB(ICdt11A11E:It'*ViTI*411i COUNTY bf-/"�0 s
ill1BLIC WATER SYSTEM NAME _ Saaen dWb � (�� . •� •c . � . � . _
Ar
Said Name /' . �'�7 L /J }�l(� � /b:� -� ly(1
Sample SlreetAddreas
R.wb City, stale zip L!./ J l o �A e' i" � &A S '� 065
To: Phone J ;2
To be dasched by Samlift CeMclor. 00— aniPWS ®Operator ❑ OCtsr
SAMPLE SWnUXECMffbA
_ lE and
DateMme Collected: Z Gi - / L� -7 ? L r T _ 0
A100111l Day yew J I T/medfDa am pt
Sample Site: /c D t, A L ` N
_ Z
Sampler NamMPlwne: ry / V - 17 5 -
!]7 r•�• (treat sptan t7rry)
C� ❑nbmbtleon E] Raw: wells ❑Gramd wabr ❑Public ❑I>istribution Raw: well
L i
❑
Ospiawl t ❑ 1i bnda c3dxwtuaon. Q°et� . _ _ ir
❑OD ❑Repeat for samples [�suftace staler " ' ❑fir [Qft p.Bttor tiaiiioie #
❑ (Lake, FW _ p0dw.
DISINFECTANT RESIDUAL (Mandatory) l - J -WL [3rme Chlorine
(Sample should not be collected /Fno residual As present) ❑Chlorarnine (Total Chlor ne)
Number of samples oolleded on this date Z
r wenewTnnv n�ener.n_ .._...._.._ ..- '___ -•
Test McMtod Used: P/A ❑ColikNt MPN ❑MTF ❑ Membrane Filtration
COLIFORM OR MS:
T941 Coliform
6gkb Found ❑ Found /100m1
Ewherlchla coil
( ` �' - q ❑Found /100m1
❑uasWfffib for ana ( belo Analyst Initlab: .
SAMPLE UNSUITABLE FOR ANALYSISmwa unsuRaera sample mum bo mpraeed warty, 24 ma t
❑Sample loo Oa. Not recervad "W 30 hour Of COAeoson ❑Heavy SILT / BACTERIA / TURBIDITY PRESENT (rilde).
❑QUMW inStAclard for analysis (100 ML. regtaiad) ❑Sample leaked in transit
❑Form kwomplete / data discrepancy (CIRCLE errors) ❑Excessive Chorine residual
F1 Orror reason: DESCRIBE:
Submk to TCEQIPUbee Elf Witter MC -166, PO BOX 13047, Austin, TX 787111 Fax PoaaWe to 612 - 23114661
H -220 GPC -2190 Rev.W -04 COPIES: CUSTOMER, LABORATORY, TCEQ
ATER SOURCE "
ma". mved
'DIISINFECTANi S11ptAl�tMnMa6pry) - Z me+L CrQodne
(Spmp+e s►ioWd not w oaf 6adtrTno ►ea7dual is presenu �+ pchbrarnme (Total Chior no)
Number of samples collected an this date
1
C'
W
Test Metltrtd Used: 184~ P/A ❑Cdiled MPN ❑MTF ❑Membrane Filtration
COLIFORM .�
T J OT Colifofm
_ Tfountl , ,.... 't=1 r1""'� L T _ r t1100rtp' - r
ihla soli
Found ❑Found /100m1
for -*Bia (— below) Am" Iniliab: l
SAMPLE UNSUITABLE FOR ANALYWS(rrrn dicta lroi.
Samiale !" iI ii1arepecad wAtlWi i;ra 1 a
bo®Id Nqt 30 fxxxs of mastliOn Heavy SILT / BACTE16A / TUR601TY PRESEFrr
t !IrtetafEBmT(100 mL requrad) ❑Sample lrralcad in trana6 �..; s -i
- a dllli' �a4pa(wy jf l.E arras): aF C.N°rn° reddr
' ❑daRIBE � - - • ' -
{
Subrra te TC¢OlPublk Water IAC -161, PO BOX 13047, Auatln, TX 71711 I Fax Poealve Iee12- 2afJaM
H-220 GPC -2190 'Rev.06_04 COPIES: CUSTOMER, LABORATORY, TCEQ