ST0702-LR091020//� �/ Q) g AVVV 14 /-0 5' vs- 40 -
Water Bacterioloav Renort / Chain of ri lictnrly Rarnrrl
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City of Lewisville Environmental Control Services Laboratory
S amples ACcepted
Customer Comments
Report #
897 Treatment Plant Rd., Lewisville, TX 75057
Monday - Thursday
phone (972) 219 -3548 fax (972) 219 -3506
8: 00 A.M. - 12 :00 Noon
/UCq - JJ
Lab ID 48146 EPA Lab Code TX01143
Sam le Bottle I.D. #
ustomer Name:
Customer
Project Name:
Project#
Address:
Project Address:
Contact:
City, State, Zip
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ity, State, Zip t
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Phone # C�
Phone # �^
�- 7G� Fax #
Water System ID#
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Sample Collection Information
r
Water Sampling Information
Analytical results
0
Chlorine Result
Type of Sample
Water
Total
E. Coli
Sample ID
°-
7
D
Lab Use Only}
Collected
Source
< Q
Coliform
N
c
Sample ID
Date
Time
E
CL
x
a u-
(Point of Collection)
Collected
Collected
Z
m
Residual
o
o
E
o
- o
o
N a
a
_
m
_
E
E
(mg /L)
a
m.
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0
a
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C
m
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a
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3
2
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a
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W
N
H
LL
Z
LL
Z
5
— -
G
W
X
-- -
G
W
X
- --
G
W
X
- --
G
W
X
- - --
G
W
X
G
W
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G
W
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G
W
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G W X
Sample Custody DocumejUatiDn
Samplers Name: # of Bottles j Relinquished by / # of bottles ry Date U
Print ® Collected L Signature
`� 1
relinquished Time ✓
Received By: / � L
# of Bottles Date /Time Relinquished By: # of bottles Date /
Print
received Received Signature relinquished Time
Received for Lab: ^ # of Bottles Date/Time /O�(l.� 9� Lab
gnat ure j�. received / Received Comments
Quality Control Data
Date / Time Analysis: Analytical Method: Sample ❑ Form Incomplete A p p roved B :
' P ❑Non- Coliform bacteria /silt present PP Y
K F Colilert TM (SM9223) Flags: ❑ Sample Outside Hold Time ❑ Quantity too great to permit agitation I��
/o 6 -v9 � ' (93 SM 20th Edition
❑ Excessive Chlorine Present ❑ Quantity insufficient for analysis
❑ Unsuitable Container ❑ Date: _
RAmnla Tvnurcl• r- _ (,—k Qom..... i. ■11..x77 �u ,nr...__.
w ... r. i nermometer 5/N: 51030428
White (Original): Returned to Customer as a report / Chain of Custody record; Yellow: Laboratory Copy (File Copy); Pink: Customer Copy at time of drop off
Water of satisfactory bacteriological quality should be free from Coliform organisms.
Results above relate only to the samples on this report.
ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAC unless otherwise noted.
This report is intended for the sole use of the customer for whom the work was performed and must be reproduced, without modification, in its entirety
Revision 1.3 3/3/2009
Page 1 of 1 Bac -T Form