Shake & Shingle-LR070927
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City of LewisviUe Laborator~
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Name of Water System
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1.,11/-.<<;
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Water System Identification Number:
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Point of Co"ection / Collected 'By" Date ' '-rrme ,(M)PM
(MoIDaylYr)
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Billing NAME " . J ,'") ,::" ,e_' ",- -
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Reporting STREET /.. . t~../<: if ..I (. ". -- ~ .J ~. <;;... ; 0 ,- ,-
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Address CITY .;.('"':'J /..'" .....'. TEXAS , ,- a.
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(ZIp Code) 3 z 5
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TELEPHONE ('f V:.,.,. -' :> ~ 3
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TYPE OF o Public Dlndividual ~ lD" :0:
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SYSTEM: tJ Other ? lif
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SAMPLE D Distribution D Special ~ Construction
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D Repeat for sample #
D Recheck for sample #
D Other
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WATER
SOURCE:
DRiver
DWell
Lake
We" depth
Ni&YIL~&bJ~~THQQ & RESULTL._-.
('PresenUAbsent: Total Coliform ,~1I'resent )
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(Colilert) E:CoIi.
6.
Absent
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1100ML".'.___--/
1100ML
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Membrane Filter/Fecal Coliform: 1st Oil. _ 1_
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Avg. _1_ ml
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UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 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-coliform bacteria/silt present, possibly obscuring and compromising lest results
D Quantity too great to permit agitation
DQuantity insutlicient for analysis (100 ml minimum)
D Other
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Analyzed by
Water of satisfactOf)/ quality should be free of Coliform Organisms
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