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l/7t A 17
,-------1 'fCJEQ Microbial Reporting f' orm
-, TCEQ Form 10525
I OW.017 Waler Syslem ldentificalion & Sample Collection Information (Please type or use block print)
Public Water System ID: I TX I 2400001
1,.i.,..\oc,l,..r-,-lr.onckO:.:<-,'.)Jl:('1t1,)
Public \1/aler System JEFFERSON WATER TREATMENT PLAN Name:
Councy: WEBB
Nzme: AN�6N �/�)
3 Address: 5816 DAUGHERTY AVE.
� a: Cily: LAREDO t: � cc. Siaie. TEXAS Zip Code: 78044
Phone#: 956-721-2000 Olher Ccnlact 956-324-8626
Sam1A�r Name (Prinl): Si�cL-
SAUL CARDONA
Oi,trmo, license::: □o·,m•r WD0014734 p Operator 0th•r: INSPECTOR
;:.,i,o�(\1c' ,,-.,.:/;n,,u:J.-rp,yr.1 "'-�1wJitt.'.).T.;.:r-:u ., ,wrc (NI".,:,•�:;, c:,.·:ci :Jo!!.r .,-,:.;,.,.· .'(�JIIJ·,.._ lic•�:f',n:;Jf;:.U. Tlk. 4 Ctu11:t· J7. •a.i Bt ,,;r..r.1 Ut:J :�n. t,�tt t•�•r <Y�V,.• l::'f�� � ,.>7;-,\-, ,.-�.t c.o.;«fc:.f ,l�l�Jt.: fl..; .:fl!t•l\lC.:.fJ:.)Jr,:: !"J�\.'<�l'(O�:f�'U. 4-"',,t1'a: ,-.,-,��U J!u..",J.;c
San\pla (dentific;;,tioon.oc.,,(fon S,n,plo1ypo: (•,'0110) Coltect&c.t S2,pplc ID � Dall: ol Us\; Spc:c1ftc Address/ location identified In Sample 'c- O-,tc Timo Drigi,,V-ogS.:,'1)1•
S1tine. Pl.lo j ·ti J(MR,p,,al
$ 5 ,_ ;; PJc;,se circle Rci)l�cemc,11, & �� .,. � .s C 0 ., TITQ:1e1cd Ra,,. 11.w, Wells • lhc Source 10 fo, Well S11mvlcd l£lC,,1op\c: � 5 � g 0 f) AM or PM -li � :;;_ >-GJ2345G7M
& � � � s,mp1.s1 rr 9. tr. a: to
/ lo 7 /t·J /.:).L. I�/ It> 1 I� l/1/s-�
cr:, .. ..._ .... ,a.-"-".�:
(§1 Public a:ea..1 th 1�_.,...,.,,,t�ll\.,\• 1•,·,••t•
Citv of Laredo Health Dcpartrnenc '-�ou,-acory Environmental .Section
,6CO Cedar Ave. Laredo. T)( 780�0
(956) 795-49011 • 4693
or� .. �,-:i:,1�;�
Tl04704368
TCEO L•�oratory ID:
rcu Ucsvlu muJc meet ol/ o«rcdi101,cm /cc,1i/,'co,:o" 1t(ju1rcml'11U tmlcJJ Jto!rcJ 01/icr,.,,sr. 48014
,. SHADED AREA FOR LABORATORY USE ONLY Samplo lcod7
Rc�rc:T�� _J J'1 r. D•�;;;ft9 � Yes 1□1 No (_',;2 C/p.,......_
l'h�!!i-:00 6)· tCo;,i.c,. it .l��n?>lc): Dale I Timi Tcmpe.raturc
iO ·l0
oc ��·?�"'"· Oiliiel Time: /4
ro/7 ;--<:; t �.,1 p Ccncc:ttJ1c.11p R<..-,,,:��
o,�Fr7,q i; .' ;i_ "8 {) ti-\Lob CG-Jnrneols. tncubJ\iori Date & Tlrno /
Beoln I Enu 1
TestedOf ';1/.
Oa:r.: IO/t/ IG l?a!a: / I.I ,y -I'
&uo Time:·r� 1!)1"'\�le. ; : s-o � Laoor
�pp,�·
c?A�Lc-v D�le: I lime.
-
'I,) �_..(I._; V. 10- <t'-/c., t,: <;;'Op Repo<:)6Cl:cn: 8y: Dal�. Tir.1r.·
Chlorino Rc,iduol Lab Results Rojetlion COile Test
1Cmq JV , .1/Cite.le ·p for Free. Iii ap,foablel
T rorlo1al Plr.asc
Re�bmi1 (mgll,)
,j. 1.5 .,.£.. T
�-7 l.f
Meu,otJ: ;\_�_ ">i - i/ Chlorine,, Total Coliform ECo/i
Absent Preson1 Ab�nt Pio.sent Absenl Ptesent
0 □ lZI □ 10 □
li2f □ � □ r;z1. o·
Laborato1y Sample 10 Number
I !JO 1 I CJo 15 }DD 111 o,G
/ lo 7 h ,tl.'15 30>
IJ.J' � [ul D lul □ g' □ J 0 o ·1 I °I 01"�
ii"'\
�
47 i f!) 71 4 'l �
j/ /6 1 If ;).} !i/ � 19 � T � □ � D 0 □ /O\J1! q () lJD
14 g /
A SJ
A1?�
14-t f 11
11 r.s I
_,,'/ (o _..v
fr.> / (o
I./ lil) I" /o
/ lo Fotm ii1Jlt\JctNn:.: w-,-w.1coq.Jexas.9u11i�rl11king,rote1l1niclooi;Jlltv>ns•t1-1olnf,e,{ilorm-tvfo
7 '?
7
7
17 7
If IJ.'>7 "" ;;.<; � '21 □ v1 □ ri2i □ tbD1J 9 Dlv
17.:: T
/7 2�() � 12.10 � 12( □ 0 □ 0 D /0D11 Gi O_'aj ""' It ').'S/ � :).. /(/ I& \21 □ '21 □ Ql D J ,� 1)1 f Cj O fl IT
Cf.'»- '* :; Yc2 �- CZl D liZl D � □ I (') ·1)11 9 oi;r-11 T
(� .t;".70 � -0 ill IZ) □ � □ -10 I o· ·,oo71qo<J--< T
I'( �:r;. � ;;,� ( __,., [Zl D lu! □ [E' D I 0 1)7/°J0</4
• Sp<-cl.i ond Conlruciion ssmp� "'" NOT FOR CO/.f PUNJCE Lab Rejecled Code (LR)· Ooa,m,nl Reason:
Gio· G 0-+(,0 (2,
9 C, to
c�·1 C1·:y
0
I
TCEQ Microbial Reporting Form TCEQ Form 1D525
08/2017
Waler System Identification & Sample Collection Information (Please type or use block print) Public Water System ID:
I TX 2400001(t.tusl be 7 d1911S: 1nCIUCO all /Ct'O\)
Public Water System Name: JEFFERSON WATER TREATMENT PLANT
County: WEBB __ ,b JI);- rJ�t;Name: ��
0 )Ju�� \l....\ os
� Address: 5816 DAUGHERTY AVE a: City: LAREDO ,:: 0 C. "'
State: TEXAS a: Zip Code: 78044 "'
Phone#: 956-721-2000 Other Contact: �56-282-9520 Sampler Name (Pnnt): Signature:
)� �JOSE LUIS GARCIA
Operator License #: WO0044484 Downer l=fapera�lother:d. Inspector FJ1s6:J:on of tt.1s f:rm or tJrrpeMg l\,:n "J!t'I' .s.11np1Ci ,, J Ctlm(' puridM�� un*r .state .:,,,d'ot lrdetiJ/ lll'I, (Tt1JJ Ptn,11 Code. Title 8. Chapter 31.10) By s9tl.111 this lomt. tile- sa,r,p,lfr aw,o��s lhlt SMJP-'ts -''tie co'Jttt�d «cordng ratt>t sylttms cst:tb�slr.d s�c�tdion f)IOUdr.tres. and Ptlr 41.wtrna.tion,s .Y.cura:c
Samplo ldonllncatlon/Locatlon Sampfo Typo : (-Jono) Colfocted Sample ID & Dato of Use Specific Address/ Location identified In Sample Dato Time Origlnaling Sample
Sitinp, Plan C � l (Alf Repeat.
0
i n ,: Replacement. &
g� "' � � c >- io Please circle :'l 0
,., ., Triggered Raw Raw Wells • Use Source ID for Well Sampled (Example: - ·s ., 0 AM or PM iB � C. i ! " ::; >-., 0 Samples) Gl2J456711) a: 0 a: a: u a:
./ \C 1 e:, I . °5 5; am
7'
v ,� l- 9 2·:32,.. om
�
J \(.) 7- '1 3' 0'=, am
�
J lo ,. <, ff3b .,,,
� J l c 1- '1 't '.Lr;
am
;,;,;;-' J \Q +- C, ··1'·'-1 \)
am
? •m pm ,m pm •m
I-pm am pm
Qty ol a.u.dol&..ah �t
����
@Citv of Laredo Health Department .;;boratory Environmental Section r' ( 26CO Cedar Ave. I
Laredo, TX 78040 *<111
Public Health (956) 795-4908 X 4693 T104704368 i•,.,�.,nl. l"hHll••I" l'lul .. .cl TCEQ Laboratory ID:
Test Results musr meet all nccrcdirotion I cc-rti{ication requirements 11nltss stated otherwise. 48014
SHADED AREA FOR LABORATORY USE ONLY S;imole Iced? Rclmquish<d By (SamplCf):
� Yes □ No , \ei�E- li...,,':) l� "'l'\.t.1,..
Date /Tome: J e ·:; b l' H \ o/:t 1q I: .
Recerled By (Courier. if appbcable): Dale /Time: Temperature
s,/ oc
Rclin'll!ishcd By (Courier)· !/• / V,_ "---j . L . .£-, :/ 1/
Dale/Ti/ / \() -:,- ,ei
e_ _s-:�-oP•, Corrected Temp \
;__/
y
r/_"�
_,
Lab Comments: -
Tested By:
•- ....---.... II Laboratory Approval� M�/Li,,Report to Cf.en! By:
Chlorine Residual Lab Results
Date;O/) /Oi e �-sz>L,<__:;Incubation Dalo & Time
Beqln, Date: I rn 1 11 q rime: 6' 00"'1\ Dale: I
End Dato: IOI 'I,( /7 Time: /,, _'{){p ofY'-Timo: I
/6 -f"-te:J 6 ia(p 1A J Date: nme:
Rejection Code M:t��d: 13)1( q;»o D6tlCircle 'F" for Free. (if applicable)•
Please Tfor Tolat. Chlorine ,J Total Coliform E.Co/1
(mg/L) Resubmit
Laboratory Sample ID Absent Present Absent Present Absenl Present Number
1�\3 L [lJ' □ D' □ cr □ /f901l9 OS fT
3-'-{ � g □ p- □ 10' □ 1001/90& 0T ,
3.3 6 u( □ (k;( □ l!1 □ /001/0J o�/T
2.. <=\ fil Gt □ 10' □ lj2f □ /f7o1! 9 ot. ::J.T
3,1' _ID_ � □ 10' □ 10' □ /0D?(9 (!}fr;3T
3.4 � g' □ 0 □ a;r □ I DrJ 119 0l If T ....!:... □ □ □ □ □ □ T ....!:... □ □ □ □ □ □ T
F □ □ □ □ □ □ T
....£.. □ □ □ □ □ □ T Form instroclions: 1w1w.lceq.loxas.gov/drinkingwatorlmietobiaVrovised-lola/-colilom1-role ' Special and Conlroclion samples are NOT FOR COMPLIANCE lab Rejected Codo (LR) • Document Reason:
.• ·-..
TCEQ Microbial Reporting Form TCEQ Fom, 1llS2S =
Water Syslcm �llritali011 & Samplt Calledion lnmm!alion (Please typo or use block print} Public Water System 10: I TI(,i: 2400001,vwto700h,.""""""'r4�
PublicWaterSysll:m '
Name: City of Laredo Utilities County: Webb ":!·
Name: Juan Rios .{i. .. Address: 5816 Daugherty Ave i a= City: Laredo
11 State: Tx ZipCoc!e: 78041
Ph:>nei;; 956-721-2000 O:herC011tir:t: · 956-721-2007Samp:etN.we (Pm!): s
zgz-
R. Estrada
Opcra:cr!Ja!nse�W00043965 bermer P OP=!Or Olha': Samolerc., -: .. =♦:;:cc'�..sL-=v�-...,.,!">a¥t"�;s:�C"":'t�'#tv-!,�,.�,..!c=c:tl!lc. ,,irJJJf("ll:Q_"(. ,, .. �I.Cr..z:<1'�; :os,,.•:v-:,:r--t!:"'r: �� !:&""':•·�:::i:-.s::-:-:���n:::::-:.-r--,0�,..:r-.:t.��_.;..-�o:-e:-,,:.��r.::1.,:""-"'o:,..,�
Sample taonUflQ!lon/1.0calion S;unpto Type: ('< OIIO) COllocled S:,,:,:,:�IOC.D�� u� Soccific Addr<nS / Lo cat ton ldcntffiec! In S.,mple D�tc T.m� <:,;p,:,: .. ,s,,,;:.
Sltini: Pion I .§ I �= :i I
i• 2 ,. ... .. �-- �&
now \Vdt.• Usc Sourc.-10 Cot Wcll 5.>mp(od (Dcamplo: � - j ., � N.lorPAf i
T,w:ralllaff i ! ""
0
Gll34SG7A) �g a: a: S:rnplos)
}/', ·'":l iC/ 11:1) �) I i I 13:� �
. ) \ \ l:tb· ¾i l:J..O � i I �.ZS-ti ) �;3S -i ) [).'.�S-¼ ) ':?,· l'\/1 �) 3,:1S-
..
.-\ l :.r {V ·s.3S r.i-
Ol:r4 ...... .--.�
@UN o! Laredo Heallh Ccp�rtmcn,
a ..::�or�tory Environmcnt:>1 Section
��2SCO Cedar Ave. La redo, 1Y. 78040
PuhlicHcclth (9S6) 795-4908 x 4693 T10470436i ----- ... _ .... ,., ........ TCEQ L:lbor.itory!D:
T,uRt'w/umwmccfallaamlilDlitJn/cr,t,{/CfJ!io,ircqufrcm<flUunlrss1101tdotbt,..,,se 48014
sHAo;o AREA FOR LABORATORY USE OlllY S>mal� !cod? �,c: ():itci,,'ltr.e:
�YG$ D No f(.� lo-1-19 J':.Jcf �M,
�:,:.de-, (Co,nt,, I �..::tier. ��;T"1'.o/. - Tcmpcnllllr� /
<ii. L{ ·c �02 _) 0.,ldT� /0- ,J7 i;-:�r-1'\.
=:e<!TCll'O lha,·�t J/ h ,A I J./ IA, ./ o,i,,m:ne: i/ , / 10 '.} I q <-/ :vf:,(J(H,,
�j "
�B! �h
'---._";§ �.�A,J,, Repolt!o�n:By:
Chlorine Rtsldunl
I � lncub21ion Dalo & T,mo Bcqio / t Eruf /
Da!e: �Of//,/ 7 IOc!o: //I/tr//., r.i:�: � .d ..LJ.run;;: //, ·�,f..__,
/tJM"'J D>le'...::.6.3., .AT,mc:J '
t,, Oalc: I TIIIIC:
!.:lb Results �Cc.!;!
111::d: l') fJ14 .)a-� J:Db!, � 'P «<Free. (ila:,;:(,C;I�-
-rrcr10:::1. f'!ea5e Chlorine 'i Tota!Col�om, E. Coli Rcsubm'l(mg,t] Laboratory Sam;,lc ID Absenl Prescnl Ab$enl Pr=l Abstnt P=nl
rlumbcr
·s.ao .0.... C!( □ rY' □ .CB"' □ loo7I Gnn1T
-:z� � C9" □ a' □ 0 □ l o0'1-/ q6oY
�,tv) 4 DY D IB" □ 0" □ 106119065 JJ �j
.£ [;J" D IJYi □ � □ 10011 qoo� T
hfS L£ [jJ" D n:r, □ li3"' □ 16 o t I qoo 1' T
.9,B jlL IZl:' □ llr' D I;¥' □ ; oo 7 / qoo'6 T
J.� � [9' D � □ ar □ l O () 7 I Cf f\()Ci�.IS- � Ef □ or □ 10" □ L06,, q 610 T
9,r;51 £ � D 10' □ lid' □ 1 o 0,1 er al/ T
.(,�t c.sL [3' □ Q-" □ Et □ '/00 7- 0/0/;_ T Fem� �.tceo��� • S)>Gtial :m��.wHrJTFOR COIJP1JANC5 Lab Rtjed,cd Ca1e Ml· Doa,a'l(r\l Rtason:
TCEQ Microbial Reporting Form TCEO Form 10S25
ca,�,J
Water System Identification & Sample Collection Information (eJcase type or use block print) Public Water System ID: I TX. JC/oono I(!.'..,..: bf, 7 41j,<11'. 1ncfl.O.) ;'Cl /dO-.)
Public Water System I 1.-l-;\i-tie.S Name: Li0 /J+ /_r, -{'° Jo
( County: \JJe,bb
Name: Al'\ .1,,...,n ,·o (Y\.C,rc ... � Address: <;-5< IL Dc.-.1,,.1. t +-v AV��...
Lc,y-.,.- Jo J (
City: t:: 0 a.
7'6' 6 '-f \State: T·-f.-.. ZipCo�e:
Phone;;: � 5� --7:J (- )oco Other Contact: 9� - ?J \- Joo 7 ( Sampler Name (Prin:): Sigr.ature:
V 1lioY ') c.-1 IV\.fJ.A.. � ,d��;;)z_ S, OperalorLicens
�:J /) !Ni\ o,3'GJ CS'
Downer p Operator 0-.her:s; yv1p/
e, 7'"c�•�,1:ci,o!t"'.a:tn::cr!JT";c,.:-:.1 �Ji "6'<""SJ1':.tsd.>C'\":"t�-:s.'\J:i,;,ur.:e- u.1:to1r.::.«:,cr.:J:J•. {Tts..J>Pi"'WC,,;:ct,. i,:c r. ��:,:,·Ji JC'JS,�,-�:Jt-s.hr.-.. ::-.e :.,� uelrc1..-ft<r;:; t'U!.!J"l'l�t� .. e:: CG,��c$ ,:co-:f ,9 tJ ::-� s1s:c..:i: u!J!: V:-::1 :.l"r�"t cott"'.l« ;r...(.e,�ns u.:ra: i·r.';;":"'".J:c, •J �c
Sample ldontifieation/loc.>tion Sample Type : Nono)
Use Specific Address/ location identified in S.ampfc
Sitinr. PIJn s ,§ (.I ·� �
1 s
.!: :s -;;
1 R.w, Wells• Use Source ID for Well Sampled (Eumple: C, 3: i!., a.
Gl234S67AI a: '2 &: .. ts-a:
X ,, X
1-·
X. :1..
'
Ix.
Date
£ >-" .. 0 0
lo 1. ID '). JC 1 le 1c
lo 11, IC�-
Collected
Tome
,., Ptease cicle ., :,. AAforP,' • .f
,q l :os-� l'i 1.n' �
/q 1·,5C �I'\ �'.IC\ � M 11',it �
� l� :>:,,_,, -� � � �
Szr..;:c 10 & Da:o � Cng,rot,:; S,,:p:e
I v-1Re:>e3C Rcpla<c""-"'� &
i Tr.ggcrcd Ra-1t
�es) a:
D
CJ0'4----��
�
<.,tv of Laredo Health Depanment
·8i..A:>oratory Environmental Sectio:i
26CO Cedar Ave. Laredo. lX 780�0
PublicHealth (956) 795•4908 X 4693 Tl04704368 , ........... , ,., ...... , .. r, .. ,,..,., TCEQ Laboratory ID:
Tnr Rt:sulu must meet au occrcditorion / ccn1/Kott0n rrq1.111cmrnrs unlns srored othcnvisc. 48014
SHADED AREA FOR LABORATORY USE ONLY S3111blclced? Re:a:w.s.� Bv 1Sa,rplcr) 0a,�1,imc:
rnrYes ,□, No v,-;ik,,r sJ,14t..'I 1cr7-t "t 4 -V -0 \D-1-ti
� P-vvt R!:<i,ed 6y (Co-,-..r. t a,;,l:able/ Da!e/T1me:
Tcmp<>r.iluro
t-1 Re:it:quishcd By (Counor) '== Oa!e/T ime:_., Of" /] IA , }D=91.'1 - '(-:l4j - --.,cu
Cotrc::od T CIT() \ �cuNoal� D?e,Ti_:e: /f;Jrfi_ 7-t'? e.
LabC::::er�
TeS!�// �.J-;,; �:ortJdP� �J. Report toCtcnl By:
Chlorine Residual Rejection Code
Circle·;:· tor Free. (� a;,;,l:wilej •T lorTo:al. Please
Resubnit(mg.'\.)
a.qi �T
I .i� �T
'J ,l{ � 'T
3,5 �T
f),q 8' �-T
o.9<o LC!2T•
...£... T ...£... T
F T F T
Incubation Date & Time Beain J End /
Da:e:/,1/7/C7 Dale://j/ d7 / 9 rrme: �� Time: _,/,•::1.L
/()/t/45 Da15
Time: I
- J...-,2) /· Dale: I Time:
Lab Results
Test JVw � -p__). R. , Method=-.. ) � ...,... c,, '-T 7\ Chlorine.; T Olaf Colifonn I
Absenl Present Absent Present
0 □ � □
&Y □ 621'1 □
[:( □ ur.'. □
I!::!', □ lid"' □
[!I □ O" □
g □ Gr" □
D, □ D □
□ □ □ □
□ □ □ □
□ □ □ □
E. Coli
Absent Presenl
m" □
� □
u?' □
� □
I;;]! □
CB" □
□ □
□ □
□ □
D □
Laboratory Sample ID Number
\(51)l / '1ol3 i o7J1 l Cfol Yl(J!J1' I q D I ) '°
o or/ 101 <oI DOt I Cj on--
I ri (), I q () \ i
Fonn illstrvclion5: w.1-w.tceq.tcxas.govldtinnngNalcrlm--aobi.JVtTMscd-t�onn-wtc • Spcoal and Contruct.:,n samp:es are NOT 1'-0R COl.fPUANCE Lab Rejeeled Code (LR) • Documcnl Reason:
l)
r;XtJ I
TCEQ Microbial Reporting Form TCEQ Form 10525
0812017
Water System Identification & Sample Collection Information (Please type or use block print)
Public Water System ID. I TX .Z...40000 l (""'usl be 7 d g1ls, indudc all 1ercs)
Public Water System
GM YD t)Name: C \ -C\{ ot:: County:
w�e.
Name Jv-ll\N R,\ 0 s.0 .... :!!! Address �f?I (, --cA v-.t; 1-{&R, T'( Arv c; ::,
c,ty L��o. t
"' State ;+ ?}-o 4 l 0:::
-rxZip Code:
Phone#. C9�f:i) � vt.-?/400 Other Contact
Sa'Tlolc· '-Jare (Pr nt) Sg
� 'S \-\ G- w C 'rt \ I') Ii\ \... � t-f\ ( Ope·ator ccnsc II
Wd4<f4\'16G Downer �Operator Other.
r als,ficabon al ttrs fam 0t lampcnng N"/n watCf samplos ,s a Clim� puntshable undet sta/o arn:Vor fccJc,al law (Tc.r.as PvnaJ Coda. t,tle 8. Chapter 3110} Ot SJgnmg lhs farm. tlro sampler
acktY.r,.,Jcdgcs that samples wcro colloc/cd accord,ng to /he syslcms estabhhod sample collcct,on procedures, and that al ,nfom,a!;on 1s accurate
Sample Identification/Location Sample Type (,/one) Collected Sample ID & Dalo ol Use Spcc,fic llddress / I ocat,on identified in Sample Date rime Ong nal sg Sample
C: (All Rooeal . Sitinp, Plan C . Q C
0 t; �� Q) .;;
i 5 >- :. Please ctrcle n
Hoplacomcnt, & <ii s: C: Raw Wcl.s Use Sou"ce 10 for Well Sa-no ed (Example 0 0 "' '" r nggcrcd RaM
:j � � f5 � ::. 0 >- AM or PM " G173'-5671\) cf.CJ "' 0 � Samolos) CY. 0:: U) 0
J /() ":} 1q tf.' 15 am
� ✓ /0 -;}- \ 0, :].'"35°"
am
� ✓ (J � ( C\ �· /cJ � ./ '" � (q &'.� � ✓ ;f (9 ).•S(} am
/0 � ""' ✓ {O ;/- I ci '.) . ,-, J ,_.') �
J 10 ::r- (q s: /0 am
� I (<> ;;,- ('J /3:3S � ...
1--pm
am -pm
TCEQ Laboratory ID:
Tes( Uesults must meet all accred,tor,on / cert1/1catron requirements unless stated O(herw,se.
SHADED AREA FOR LABORATORY USE ONLY ,
s..rnole Iced? rMnqu,shod Dy (Sa•nplor)
E1f Yes □ No sHG\i\J L-V)"1\Reco,vcd lly (Co,,r,or, ,I appl coble)
Temperature
o/-�c Rel,nqu shod By (Couno
./�- ;J
Corroctcd Temp � J(f;,A� ,/
Lab Comments: -
Tested By: If:-:., /) I v1vl
Laoor3J/rl.ro;;/4.#!J
/t) (v - _.J_ . - -<f--;q
Repott to Client By:
Chlorine Residual Lab Results
-Date/ l,me ( b l'.:f-{t� T $,(, 4,'. P·M
Date I r,mc
Date/ r,m{ ! \ D it"° \'\ 4 : �0 'P'"""
voli1A/J tG j
./,;r1£J( lncuba{fon Date & Time f
Beqin Erul , _ Date:/O/?/l':l, Date: Jq'O fl/ Time: t./_',:, C, Time: ,st'��
�c-p,_) Time:
Date: I Time;
Rejection Code
C,rclo T '.or f roe, (if applicable) Please
Tosi hi � Method; Ji/'tJd-,,., 'lt:1(
"I" for lotal. Chlorine v Total Coliform E. Coli Resubmit (mg/L) Laboratory Sample ID
Absent Present Absent Presenl Absent Present Number
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Form instrudions: www.tceq.fexas.gov!drinkingwaterlmicrobiaVrevised-total-coliform-111/e • Special and Contrudion samples are NOT FOR COMPLIANCE Lab Rejecled Code (LR) · Document Reason:
TCEQ Microbial Reporting Form TCEQ Farm 10525
OS.'2017
Water System Identification & Sample Collection Information (Please type or use block print) Public Water System ID.
I TX 2400001 11.•1111 tit: 7 d") I� •ndUC(I �·1 ,crot)
Public Water System Name: JEFFERSON WATER TREATMENT PLANT
County: WEBB
Name: ANGEL LEON 0
5816 DAUGHERTY AVE. 2 Address:
0:: Cny: LAREDO t:
"' 0:: Stale: TEXAS
Pnonc #: 956-721-2000 Sampler Name iPrnt)
SANTIAGO MOTA Opera'.o,l,cense�
WD0014297
Zip Code: 78044
Other Contact: 956-33 7-0083Signatu•e
Downer p Operator Other: INSP r,rskJ'<¥1of t'li, :'J'"nt' lil"'ot·r,11, �.,,J· 111•�• wrrpl(Js11, .lC'•'N nv"'mJ.�e f,:f;J(>' !Ja:11,1.•,r.:n:l«14Y�'UW (i,Y1• f'i•"-t'C(yj{' T:!? R r.:-.ipu,r 37 J�)Bf SJ9r.�tt..s tom, me urt·�· i..�,v,11"�.s 1t,.J' sJ.'T'lp'cs �·,.,e ro-"«lcJarc�J•�) totJ,c 5�s:r':'l� fSt1f>'1i':rd ,amp!� coi:f!rQ!'I CttX"C<l!.,,s.. :m:t r11.,t 1t.lf111'c'l"'IJt:o., 1, «cum�
Sampto ldonlificallon/Locallon U!>.e c;pecific Addrc'i� / location 1dcnHflcd 1n Sample
Siting PliJn
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Sampto Typo (� ono)
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Sample ID & Date ol Cngi.,atrgS-l��e
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@Citv of LJredo Health Department .,,;_
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�� c<,otJratory Environmental Sewon tNI 26CO Cedar /\ve.
"Oj� Laredo, TX 78040 Tl04704368
Public Health (9�1(j) 7%-4908 X 4693 1'1"'"'1\1 l'r ,.,,.,, I' •;<* I TCEO Laboratory JO:
T'7st Results t11U,St mc:ci all orcrcrl1tC1Hott I ccrr,j,c,won re,,cnremC'nl'> ufl!C'U stmt:d ocher.\'IH' 48014
SHADED AREA FOR LABORATORY USE ONLY
Sample lcod7
� Yes □
Temperature
3, LI. Conccled Tcnip
L'.lb Commcnl�· .11
Re• rqu,st,ro 61 (S;~p'c•l
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Chlorine Residual Lab Results
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JtJ-P-11 v: S'D P, Date: Time
Rciect,on Code M:t�1�d: l V/l7 9&?J7i)�k"-, / Circle "F" for F rec. c,r applicable)-
Please ,·ror Toial Chlorine ,J Resubmit (mg'L)
Absent Present /
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Laboratory Sample ID Number
ID O 7 / q Dt!; IOD7l9Dfo4
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folm L1stll1d1ons: 1w1w.1ceq.1eras.govtdrinlongw111orlmictobia!lrevised·to/al-c-Ol:foan-ru/e 'Special ar.d Con/ruction samples are NOT FOR COMPUANCE Lal> Rejected Code (LR) • Document Reason
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TCEQ Microbial Reporting Form TCEO Fonn 10S25
Water System Identification & Sample Collection Information (Please type or use block print)
l!tv of Laredo Health Department L;.:,ur;itory Environmental Section
26CO Cedar Ave. Public Water System ID: l TX ..!Jil,,.rJ/"VV") / .,,u-.t1x,1c:,o.t-:..1ria..c.,.-.:1,'.f0'\) � V\: T U�
Public Water System Name:
La redo, TX 780�0 PublicHealth (956) 79S-4908 x 4693 no4704368
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Sampler Name (Print): Sigr.atute: --........_ --;/"7 � � rime: /.,,,/ .-\IJ Time: / • < 0 /., �
1<ACV\o/J MAC-1 �s - � <�:ory'Jt/""� t..i -; 1 1c/.P/2t; € d,°J�Tune: -
Operator License�: C}J � tJ{J f d,. :;q If Downer p Operator Otheo/Jn/{(if Repo,t lo�nl By:
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Sample tdentificalion/location Use Specific Address/ location identified in S-,mple
Sitinr,Pl;m R-lw \'/ells• U>e Source 10 for V/ell Sampled (Example:
G12l4S67Al
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Samplo Type : (-1 one)
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(rnn.'L) Resubmit Tr,;ge,cd Raw ···,
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Date: Time:
Lab Results
Chlorine o/ Total Coltform
Absenl Present Absenl Presenl Absent Presenl /
Laboratory Sample ID Number
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ij2I' □ V&771 f/tJ 9'f □ Foon ins/1"1Jc1xlns: www.tceq.rcxas.l)Ol1dtin!ing"Nalcrlm.'aobi:i!l1oviscd-tolakc/Zonn-rulc . s� and CMln,C(jon samp:C$ /J/0 NOT FOR COMPUANCE Lab Rejec:ed Code (LR). Documcnl Reason: