ST0701-CS100127T H E • C I T Y O F
P.O. Box 478
255 Parkway Blvd
Coppell, TX 75019
Phone: (972)304-3679
Fax: (972)304-3570
5T 07 -01
ENGINEERING DEPARTMENT
FAX COVER SHEET
To:
e
From: /C IC
F ax: 1 00v Date
Phone: Pages: ` (including cover sheet)
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IF YOUDO NOT RECEIVE ALL OF THE PAGES PLEASE CALL (972) 304 -3679
"City of Coppell Engineering - Excellence By Design"
Water Bacteriology Resort / Chain of Custody R ecord
City of Lewisville Environmental Control Services Laboratory amp es A ccepted Customer Comments
Report
#
LENVI;;N ILL E 897 Treatment Plant Rd., Lewisville, TX 75057
Monday - Thursday
D O WT � � ��u�. S
Rrv,re. phone (972) 219 -3548 fax (972) 219 -3506 8:00 A.M. - 12:00 Noon
W/ �,� (%��lc L ip
Lab ID 48146 EPA Lab C ode TX01143
Sam le Bottle I.D. #
ustomer Name:
Project Name:
Project#
L4/ I l
ustomer Address:
Project Address:
Contact:
ty, State, Zip ) h
ity, State, Zip
Phone #
hone #
Fax /�
Water System ID#
Sample Collection Information
r Water Sampling Information
Analytical results
Sample ID
c
m Chlorine Results Type of Sample Water
Total E. Coli
>
(Lab Use Only)
Z
Collected Source
.�
c a i
Coliform
y
Sample ID
Date
Time
£
a
X
o
E
Q
(Point of Collection)
Collected
Collected
'
Z
@
o-
Residual
o g
N
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2 0,
_
°
�, Q
E (mg /L)
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a o 0 0
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(n
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W
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W
X
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X
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W
X
1
G
W
I
X
Sample Custody Documentation
Samplers Name:
riot 1.ti CF
# of Bottles Relinquished by:
f
Collected Signature
c Y
o
# f bottles
Date /I .—
t '
Received By: i#
of Bottles Date / Time
�/
Relinquished By:
relinquished
# of bottles
Time
Date /
_
riot
received Received
Signature
relinquished
Time
Received for Lab: `
ignature
# of Bottles '•} Date /Time J ! q L _. �V z Lab
V
received j Received
t� Comments
Quality Control Data
Date / Time Analysis:
Arialytical Method:
�-
D "Colilert rnn
Sample ❑Form Incomplete
Flags:
❑Noo- Coliform bacteria /silt present
Approved B
PP Y:
(SM9223) ❑ Sample Outside Hold Time
SM 20th Editionf
❑ Quantity too great to permit agitation
' r
13 Excessive Chlorine Present
❑Quantity insufficient for analysis
❑ Unsuitable Container
❑
Date:
" White (Original)
sample I ype(s): G - Grab; Sample Matrix: W - Water; Preservation: I - samples iced down 1. Thermometer S /N: 51030428
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.
11 F 4-1
Revision 1.3 3/3/2009
Page 1 of 1
Bac -T Form
TRANSMISSION VERIFICATION REPORT
TIME 0112712010 14:00
NAME
FAX
TEL
SER.# BROF7J659084
DATE J I ME
01/27 13:58
FAX NO./NAME
92144968041
DURATION
00:01:30
PAGE(S)
02
RESULT
0K
MODE
STANDARD