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~. City of Lewisville LaboratorY ; 1 ~ {lj V ~ i' f ~
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/ ~ame of Water System ;; County ~ ~
Water System Identification fber <~' 7 ., ,,'7 ~ I v""\
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(MDlDayiYr) N
NAME 9~j5A8 a . ·
t":}J
Billing
Reporting
6
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T~LEPHONE ( .
1
-ri Publici
DOthei ~ \,
D Distribution
,
III . ConstructiDn
stREET
Address
Dlndividual
TYPE OF
SYSTEM:
SAMPLE
IS:
D Special
o Repeat fDl' sample #
D Recheck for sample #
D Other
WATER
. SOURCE:
DRiver
ilI'lake
7~ (J
DWell
Well depth
Chlorine Residual
LTS:
Present
Present
"..-- Absent =-.::::>
Absent
/100'-4l
1100Ml
MembraneF,ller/FecalColiform 1st Oil _1_ ml 2nd _1_ ml
Avg _1_ ml
,
~
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t UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.Jc.I:)
~ D Form InCDl'l1plele (see attached item)
F 0 Sample too old, not received within 30 hours of collection
D Excessive chlorine present in sample
D Unsuitable container
D Heavy, non-coliform bacteria/silt present, possibly obscuring and comprofT1lsing test results
o Quantity too great tel permtl agitation
DQuantity insufficient for analysis (100 ml mimmum)
D Other
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Analyzed by
Water of satisfactory quality should be free of Coliform Organisms
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be replaced within 24 hours.
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Coliform Organisms
PM
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must
D Forni InCDl'l1plele (see attached item)
D Sample too old, not received within 30 hours of coIlectioo
o Excessive chlorine present in sample
D Unsuitable container
D Heavy, non-cDliform bacteria/silt presertl, possibly obsCjJring and compromising test results
D Quantity too great to permit agitation
DQuantity insufficient for analysis (100 ml minimum)
D Other
~
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I100Ml
/100Ml
ml 2nd
ml
CDnstrucliDn
CltlI of Lewlsville Laboratol'll J,
Water Bacterioloa!Y n I
free of
Chlorine Residual
Analyzed by
Wafer of satisfactDI'Y quality should be
DWell
D Special
_1-
ml
D Individual
ake
D Repeat for sample #
D Recheck for sample #
D Other.
siD,
iform
"
D Distributioo
A
F,lter/Fecal Coliform'
Avg
d1epth
Q>Ubtic
D Other
DRiver
TELEPHONE
Billing
Reporting STREET
Address' CI
Well
WATER
SOURCE:
TYPE OF
SYSTEM:
M.P.N.
(CDliIert)
Membrane
SAMPlE
IS:
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UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be rep/aced wdhin 24 hours.)
D Form Incomplete (see attached item)
D Sample too old, not received within 30 hours of collection
D Excessive chlorine present in sample
D Unsuitable container
D Heavy, non-colifDrm bacteria/silt present, possibly obscuring and comPl'Dl'nising test results
D Quantity too great to permit agitation .
D Quantity insufficient for analysis (100 ml minimum I
D Other
I
PM
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County
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Coliform Organisms
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CoI1!I1l'IJctiI
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Chlorine Residual
Analyzed by
Water of satisfactDI'Y quality should be free of
\
System Identification Number:
/ 1./ .......:-;:4
j / (.:.~ / I . I;' ( ":' ~)
CDlIecIed By Dale .
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City of Lewisville Laboratol'V
Water Bacterioloa!Y
/100Ml
/100Ml
ml 2nd
D Special OJ
DWell
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r
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lstD'I._/_
_I_ml
Dlndividual
LTS:
Present
Present
}/
1-
(lllake
D Repeat fDl' sample #
D Recheck for sample #
D Other.
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ame of Water System
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f..,// (_ _J
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....-..
Total Coliform
E:CDli.
Coliform
Avg
STREET.
)/,.
CfTY I' ',:,//
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TELEPHONE (
D Distributioo
/
riJPublic
D Other
Well depth
DRiver
NAME
M.P.N,
(CDlilert)
Membrane Filler/Fecal
WATER
SOURCE:
TYPE OF
SYSTEM:
Reporting
SAMPLE
IS:
Address
'"
..
Water
Billing
l"
City of Lewisville LaboratorY -.
Water Bacteriolo!!y
)-, J
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,,' Name of Water System
Water System Identification Number:
/1" I /".."/ I . 'II"
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Poot rJ ~DI1 Collected By
Billing
~~' --//
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Date' Time .J(I PM
(MalDayiYr)
~-/';4
NAME
Reporting
Address
/.. A
CllY /,....J G/.A", /.) ,
?'
(Zip Code)
50Cf- ~.138C;
TEXAS
TELEPHONE
~/fJtl
TYPE OF
SYSTEM:
-ci Public
D Other
D Individual
SAMPLE
IS:
D Distribution
D Special Q ConstrucliDn
D Repeal for sample #
D Recheck for sample #
o Other
WATER
SOURCE:
DRiver
-S lake
OWen
i
! '"
l..)
-
Well depth
Chlorine Residual
r~ ~A'~~~:~L~~sent
I . .. Present
M.P.N. Total Coliform
(CoI~ert) E:CDli.
---- -=::>
__ Absent
Absent
1100Ml
1100Ml
MemblaneFillerlFeca/CoIdonn: 1stDil. _1_
ml 2nd _1_. ml
Avg. _1_ ml
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UNSUITABLE FOR ANAlYSIS: (This unsuitable sample must be replaced within 24 hours,)
o Fonn Incomplete (see attached item)
D Sample tcJD Did, nol received within 30 hoors of collection
o Excessive chlorine present in sample
D Unsuitable container
o Heavy, nan-colifDrm bacteria/silt present, possibly obscuring and compromising test results
o Quantity too great tel permit agitation
D Quantity insufficient for analysis (100 mt minimum)
o Other
-~ ~
Water of satisfactDly quality should be free of ColifDl'm Organisms
"Ci~ 'Of LewisJf~~o~~
Water BacterioloJ!Y
(/ 1 ') . i.J L
8 Jt of Walef System
BiKing
Water System Identification Number:
,/ --.)c~) I /.3:/ / /L/ /lv ..: - -Z "1.(:j'l'9 ;0
Point of Collection Collected By Date ---nme ItIi PM
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NAME-y::.,,,j, ~/---c../ ') 0
Reporting
t. Address
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STREET ..J / () ( )
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~ TYPE OF ic
t. SYSTEM: ' 0 Other
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If
If
jl
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D Individual
D Special
SAMPLE
IS: '
o Distribution
Con~on
,~ D Repeat fDI' sample #
D Recheck fDI' sample #
o Other
'5/Lake
DWell
o RiVef
WATER
SOURCE:
0.4-
Well depth
Chlorine Residual, :
i
: ANAlYTI; u~~nnR. ~lTS:
, rCPresentlAb_t:. TDlaI~ Present
~ t (CoIilert) - J E:CoIi. Present
f M.P.N,~: _-;:lo1aI~D1ifDrm
. t (CDIdert) E:eat.
Membrane Filler/Fecal Coliform 1st Oil. _ 1_
-.~
Absent,
1100Ml
1100Ml
ml 2nd _1_, ml
Avg _1_ ml
I
,
~ ~'
I UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hou,s.)
t 0 Form InCDl'l1p1ete (see attached item)
F 0 Sample too old, not received within 30 hours of coIlectiDl1
l 0 Excessive chlorine present in sample ~. ,
f D Unsuitable container 1 ·
o Heavy, non-colifurm bacteria/silt presen.ssibly obscuring and CDI'1lpromising test resutts
D Quantity too great tel permit agitation,:
o Quantity insuffICient for analysis (100 mI minimum)
o Other
'v
Analyzed by
Water of satisfactory quality should be free of Coliform Organisms
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