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Get TX TCEQ 141-C 2009-2021

3. Name of PWS 4. Mailing Address 5. Telephone # 6. Fax # (if any) 7. Population Served: ________________ 8. Person Responsible Name 9. Signature 10. Agency/Firm 11. Date 12. Telephone # PWS Technical Information - Initial Tap Monitoring Results: 13. First Round Tap Sampling Dates: From Parameter # Lead 14. 15. 16. Copper 17. 18. 19. 20. Minimum Sample (mg/l) # to ___________ Maximum Sample (mg/l) # 90th Percentile (mg/l) Second Round Tap Sampling Dates: From __________to __.

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