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Get Victoria City - County Health Department Sample ... - Victoriacountytx

Te Received mm / dd / yy Public Water System ID Report Date seven digits (REQUIRED) mm / dd / yy Public Water System Name Send Sample Results To: County Name Address City, State, Zip ( Phone (area code) ) Owner Operator Other Sample Collection Data Date / Time Collected: Month Day Year Time of Day am pm Sample Site: (Address or other description - do not use sample site number) Sampler Name / Phone: SYSTEM Type SAMPLE Type (Public Water Systems only) (check ONE) Distribution.

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