Northlake 635(13)-LR061219Ciri+ of Lewisville Laboratory
Water Bacteriolo~s+
f~E~CEIVED
'DEC 21 20~
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Name of Water ystem -fi. county
Water System Identification Number: (~ ;.y )' ,, i K ~~ ~ ~ %~~ ~ l j
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o~nt o ecbon y ~ ~d IPM
(MolDaynr). -..
slmny NAME St'j 1 r~ / ,
R@pOrting STREET ~~/ ~' ~• K S T F~ )! l
Address ciTV < A~iuw1/~t' TExAg _ ~~f~-~
f' (Iap Code)
TELEPHONE K7~7 1 SUS ~,~ ~~
TYPE OF ^ Pudic individual
SYSTEM: ^ Other
SAMPLE ^ Distribution ^ Speaal Consu))rdgn _
Is: 1
~tepeal for sample #
F` -^``Red~edc for sample # .
[ ^ Other
WATER ^ River take ^ WeN ~:
SOURCE:
Well depth Chlorine Reaidut~
#.k ~ ~1. _
~enUAbsent Total Colif~m_ f PreaeM .C,` AtieeM ~
(ColiertJ"-""'E:'LTo .r- Present ~r t"i
M.P.N. Total Cdifortn /100ML _
(Calilert) E:CoG. /100ML
Membrane FiNxlFecel Colilorm: 1st Dil. _ f _ ml 2n,; _ 1 ~.~ ml
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1NSUITABLE FOR ANALYSIS: (This unsudable sample must be rt+placed within 24 hours.)
^ Form Incomplete (see attached Asm) `~ /}cam
^ sample too old, rat -eceived vtAd>in 30 hours of cdleaion ~ /Lc~,C t~~r~ F1~~ / i l Z . ~~
^ Excessive chorine present in sample `
^ Unsuitable container f
~° t ~ ~ ~ Act c
^ Heavy, ran-colifonn baderialsilt present, possibly obsauing and c~rtrprgmising lest res
^ Quantity loo great to permit agitation 'i" ~ D C .
^ Quantity instrlBdeM for analysis (1110 ml minimum) ~ ~~ G~~f ~0 l~ ` b
R~~
^ Other
- f
Analyzed by
Water of satisfactory quality should be free of; form Organisms
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