WA9601B-LR 990819T~/A:T~R" Lobm'.'480~0 .....+i817)871-7245t
Date and Time~c¥. ~ ~) ~ ~ Date
DO NOt Mark Above This Line-----Please Print BeI~t~L~NT~EN
NAME OF WATER SYSTEM ~
~- ~ ~0~ ~LE~A~LE;OE~IPTIO~~ ..... Water S~te'm I.D. No.
RESULTS 'STREET ADDRESS (P.O. Box)
' ci~
PHONE a COUNTY
Collation Month Day Year TiME AM/PM Collected By
~P ~ ~Distribution ~Raw ~River ke
~l~ivi~! ~Bottl~ ~struction DRyeat ~Wefl
~Sc~ol '~':' ~V~ded DGlycol/SwetlChi~ Water ' Well Depth
~ Other Chlorine RHi~al
Additional ~fo~tion:
LABORATORY REPORT (Do no write below) TECH
Presence/Absence Most Probable Number (MPN)
Coliform Organisms Coliform Organisms Carlform Organisms
C2~Jot Found D t ~- [] Not Found [] Not Found
[] Found [] Found [] Found
[] Total Coilform group Total Coilform/1 O0 ml Total
[] Escherichia col/ E. coli/ l O0 ml Coliform: MPNI100ml
[] Repeat samples required __Fecal Coliforms/lO0 ml E. colZ' MPN/IOOml
[] Unsu tab e -- See be ow I E:2 .U~,uitable -- See below ~ Unsuitable -- Seebelow
UNSUjl'ABLE FbRINALYSlS--PLkAj!~ RESUBMIT .... : '" --
[] Sample too old. Sample nat received [] Ouantity insufficient for analysis
within 3g hours of collection (100 ml. requiredJ
[] Date discrepancy or form incomplete [] Heavy {silt/baCterial grewthl present,
{See encircled item) possibly cornpromising test results
[] Leaked in transit [] Sample received on Friday
[] Quantity ioo great to permit agitation [] Other
[] Excessive chlorine residual:~.mglL
H-220 GPC-2Ig0 REV. 6-97
· ' ., Ft. Worth, TX 76107
WATER BACTERIOLOGY Lab .o. 480.~8171871-7245
:'~ ~,~. Date
Date a.d Time .a'd: ~:: ~ ~ ~: .... : ':.., . . . :: i.;
Sample No. ~ ~ ?~ ';
Do Not Mark Above This Line ----Pieall Print Below with BALLP01NT PEN OR ~PEWR~ER:
NAME OF WATER SYSTEM
' ' PdlN~ OF COL~C~NISA~PLEDESCRI~jOJ ..... Water Spare I.O.
NAME
RESULTS ~TRE~ A~RE~ (P.O. B~x)
CIW (~p Coe)
~ ~ONE l COUN~
I I'1-1'
billion Month Day Yet TIME AM/PM
, ~PE OF SYSTEM SAMPLE JS WATER SOURCE..
D~ubl~ Ogai~ OO~r~tm DRaw ORder ~.ke
~lnmvi~al ~Bottl. ~'Onslructi. ~Repeat ~Well
~School ~Vended ~GlycollSw~lCh~l Water Well D~th
~ 0t~ Chlorine RH~I
Additional IMor~:
MHRATORY REPORT (Do no write bdo~ TECH
, , , , , , , ~%,, , , ,, , ,, ., ,,
MMO-MUG Membra~ Filtation {MF} ' '~o-MU'~ .........
PrannceJA~nce MHt Prohble
Colifom Organbin hlifom grinbin Cellfore
~Not Found P ~c. ~ Not Found ~ ~t Fou~
~ Total Colffo~ gro~ Total Coilfermi1 ~ ml Total
~ E~her~i cell ~col~lO0 ~ Coilform: MPNI10~I
~eat sables required F~al Colifo~sllO0 ml ~c~Z' MPNI10~I
~ Uns~t~e -- Se ~w ~-~it~ -- ~ ~w ~ .Unsuitable --
"'" 'UNSUffAB~E'Fd/A/A~YSIS--PLEA~'~RESUBMIT '
~thin 3g ~s of cQ~don (1 O0 ~.
~ Date ~scr~ancV or from ~co~lete ~ ~vy (~tlb~t~/;o~) Feast,
(~ eckcl~ ire) po~b~ co~g test re~ts
~ LM~ ~ tran~t ~ Stole f~ ~ Frjy
~ Exca~ c~ r~: .~L
,- ,iTkARRANT COUNTY PUBLIC HEALTH LABOJIi~T, ORY
VV'/~T~R'I~CTEI~IOL~)~ .. :.~% 18001~)sityDr. 1:t. Worth. TX. 761,02
Lab ~. 48010
0ate and Time ~c'~. ~ :~ L~ ~ Date ' ~
Do Not Mark Above This Line ----Please Print Below With 'B~LC~OIN~EN OR~RITER:
NAME OF WATER SYSTEM ,
NAME '
RESULTS JTR~ ADDRES~ (P.O. Box}
PH0IE I COUNff
"'"'"" .... [' I I"1 I
Time of,,
Colictill Month Day Year TIME AMIPM Colle~ed By
DDairy DDistribmiun ~Raw ~RNe, e
~v~, ~Bottled ~nstructio. DR~t DWell
DSchool ': ~V~ded ~GlycollSweetlChill Water Well Depth
D 0t~r ~lorine Resi~l
Additional Information: '
, ..... ~ .... ~.- .~ .... ~ =.,LABORATORY REPORT (Do no write below) TECH
· .,~': ' :,7';'~C":7'~,:*""~=,~,'!:' :""" ~!'~i ,~,,; r,, ,-',,;,,,' ,,,,;;~, .,.~..,,.
' ' "'MMO-MUG Membrane Filtration (MF): ~: MMO:MU'G"' .......
~!:!' Presence/AbsenCe Most Probable Number
Coliform Organisms Coilform Organisms CoiNform Organisms
[Not Found D L ~-- [] N~t Found [] Not Found
Found [] Found [] Found
[] Total Coliform group __TotalColiformllOOml ~; Total
[] Escheric~ia coli E. coli/lO0 ml j Coliform: MPNIIOOml
~ Repeat samples required :~ Fecal Coliformsll O0 ml ~ E. celZ' __ MPNI
[] Unsuitable.--~.bslow ,.. E~'~ji~uitable -- .~Sp~_~o'w ~ Unsuitable -See~!~w
UNSU~i'AI LE II)ii~ALYSj~-:P['~A~ RESUBMIT ~- ' ...... ~,:=
[] Sample too old. Sample not received [] Quantity insufficient for analysis
within 30 hours of collection (100 ml. required)
[] Date discrepancy or form incomplete [] Heavy (siltlbacler~jel growth} present,
(See encircled item) possibly compromising test results
[] Leaked in transit [] Sample received on Friday
[] Ouantity too great to permit agitation [] Other
[] Excessive chlorine residual: mg/L
· L ~ 8-220 GPC-2IgO
..~
~LARRANT COUNTY PUBLIC HEALTH
WAT~ER ~;CTER~OLC~'Y '~=~. Lehm:.:480t0 'F~Lw°rt--?8~8~-67~°4~
Date and Time Rec'd. ~' Date ,,,
Do Not Mark Above This Line -----Please Print Below w, ith BALLPOINT4HEN OR TYPEWRITER:
"~ ~ u '~"".'.~-~ ',w~ts~,:~f.:
~,.
~ ;' RESULTS , STREET ADDRESS (P.O. Box1 "'
' CITY
· ' ' PH COUNTY
I;ollantien Menffi Day Year TIME AMIPM Collected
/TYPE OF SYSTEM SAMPLE IS WATER SOU[~ake
I"'~Public ['lOairy ['lDis~ibution t"lRaw I'lRiver
[']lndividu;]( r"lBottSed E~nstruction I"lRepeat r'lWeli
I"]School r"lVended r'lGlycol/Sweet/Chill Water Well Depth
[] Other Chlorine Residual
Additional Information: "
MMO-MUG Membrane Filtration IMF) ':"'
ProsencelAbsenee Most Probable lumber IMPN)
Coliform Organisms Coliform Orpmsms Coilfarm Organisms
FINot Found ~ t ..-' [] Not Found C:] Not Found
Found [] Found [] Found
[] Total Coilform group Total Coilfermi100 ml Total
[] Escheric~ia coil E. coli/ l O0 ml Coilform: MPNI100ml
*'* *~E] Repeat samples required ', Focal Coliformsll00 ml ,~ E. colZ' MPNI100ml
._El Unsuitable--~See b_e~w t ~uitable--~,~lrb~low ~. Unsuitable--,Ses~Jg~
' ' "UNSUITA ,E~Oir/(NALYSIS--N~FSE RESUBMiT ~' ".~-~. ~' .......
[] Sample too old. Sample not received [] Quantity insufficient for analysis
within 30 hours of cellectioe (1 O0 ml, required)
[] Date discrepancy or form incomplete [] Heavy (silt/bacterial growth) present,
(See eftcircled itch) possibly compromisin9 test results
[] Leaked in transit [] Sample received on Friday
[] Quantity tQO great to permit agitation [] Other
[] Excessive chlorine residual: mpfL
H-220 GPC-2]90 RE¥,