Bethel BP-LR071130
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I....... City of Lewisville Labor'. ~(y -
Water Bacteriology (It. E't" ~ vi e a.../
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Name of Water System - County
Water System Identification Number:
I If g (!It/vt! ~ 1C!),1 .,;. I h~,1. 07 ,,: C17A-'
POint of Collection Colrected By Date Time ~ PM
V . Elf t(.,. (Mo/DaylYr) I
Billing NAME P c. I' ( 0",- s t "\ oJ C t t) v"\
I p.O IJO\~ .19P
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Reporting
STREET
Address
\ .', ( K . '.'1 'Ii, ,'" ,(
TEXAS j ~d)D
(Zip cte)
CITY
TELEPHONE
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TYPE OF
SYSTEM:
~ Public
DOlher
Dlndividual
!
SAMPLE
IS:
D Distribution
D Special ff Construction
l
I... WATER
! SOURCE:
D Repeat for sample #
D Recheck for sample #
D Other
DRiver
~ DWell
Well depth
Chlorine Residual
~
Absent
/1ooML
/100ML
Membrane F,lter/Fecal Coilform. 1st Dil. _1_ ml 2nd _1_ ml
Avg. _/_ ml
I
f
UNSUITABLE FOR ANALYSIS: (This unsuitable sample must be replaced within 24 hours.)
o Form Incomplete (see attached item)
o Sample too old, not received within 30 hours of collection
D Excessive chlorine present in sample
o Unsuitable container
o Heavy, non-coliform bacteria/silt present, possibly obscuring and compromising test results
o Quantity too great to permit agitation
o Quantity insufficient for analysis (100 ml minimum)
o Other
M
Analyzed by
Water of satisfactory quality should be frep, of Coliform Organisms
N
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