Wynnpage N 2&3-LR060629
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Ciw of Lewisville LaboratorY
Water BacterioI01l~
County
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Nan6 of Waler System
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~~/ $ystem Identifi4;ation ,Number.
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Point of CoIlec1ion
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Billing
CoIlecIed BY! Dale
_ (MoIDaylYr)
NAME J 7!-.7 E / 5 /l.~ J:.:- Y ", '
STREET ~,/ (~) / ,[ S" h /) d '/ (;) /' &'v '.t- I( cI
Tme
Reporting
Address
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CITY. ' Y ,
-7 (,) .' {.)
TEXAS"-'/ ...J L - V
(Zip Code)
TELEPHONE.
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TYPE OF
SYSTEM:
~MPLE
IS:
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o Other
o Individual
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o Special . rr
o DisIribuIioJI
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Conslnic:tion
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o Repeat for sample #
o Recheck for sample #
o Other
WATER 0 River
SOURCE:
o Lake 0 WeN
Chlorine Residutl -
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WelldepIh
t~;::t MI!~~~~~~t
(CilIiIert) E:CoIi. Present
M.P.N. Tolel CoIform
(CoIiIert) E:CoIi.
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Absent
/100ML
/1ooML
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Mem,... rlll8rtfecll CoIi1alm: 1&1 Oil. _ 1_ mI 2nd _1_ mI
Avg. _1_ ml
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UNSUITABlE FOR ANALYSIS: (This unsuitable sample must ~/aced within 24 houi;s.)
o Form InCOll1llete (see attached item)
o Sample too old. not received within 30 hours of coUection
o Excessive chlorine present -in sample
o Unsuitable container
o Heavy, non-coliform bacteria/sill present, possibly obscuring and CQ!1lpromising, tesl results
o Quantity too great to pennit agitation
o Quantity insullicient for analysis (100 ml minimum)
o Other
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Analyzed by
Water of satisfactory qua~ t>uld be free of Coliform Organis~
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