Sales Tax 09-LR110225 (2) Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory Samples Acct Customer Comments Report #
LEWISVILLE 897 Treatment Plant Rd., Lewisville, TX 75057 Monday - Thursday ‘ - R - . Cll ' )aC»rwc -K_
0.p Ike.ocs. B.cal4Vr„w,. Br l .Fum. phone (972) 219 -3548 fax (972) 219 -3506 8:00 A.M. - 12:00 Noon m�: C li r
'Lab ID 48146 EPA Lab Code TX0114311 IISample Bottle I.D. # 1 I I 1 _1 1 c 1
Customer Name: Project Name:., p Q Project# / 2,/ Lc_
Customer Address: Ir 1/i / U I ,___ ..._50 , 0 j fL `J r, . „:4.e. _ t.y .. / I y Project Address: Contact:
/
City, State, Zip Gam i ' 1 1 „ i ✓" 7i5-0c) (,.r ��) / t City, State, Zip /`'�., ' Phone #
Phone # 2i 7.) - J u ( - rr- rJZ-11( ' Fax# CI - 2 _ ,2 t(/ _ r> { , ; 7 � / Water System lD# t ! 77 / '7 ,-, U . (
+( Sample Collection Information `r ` ! Water Sampling Information a Analytical results
N
o -.
Type of Sample Water ca ;, 13 Total y
m Chlorine Results .. , E. Coll ,,
Sample ID Collected Source ¢ ` Col c
ct (Lab Use Only) 2 N Q vt D E
Sample ID Date Time E a L' P L E o N
T
(Point of Collection) Collected Collected 2 17-1) z m m Residual ` _ .o o
0 Q a a E (mg /L) _ a m 2 "6 0 ° E U .o 17 'o 2 o Sa i
O m E c9 0) ro m 3 y i c y 2 co @ 0 S LL 8 LL 2
m o m o- o o 0 0 0 o c
m u) u) I _ u o v) c) to cn r ui Li _ z u- z D
-I 7 5 C (8.A. C r c k 1- ,Jq (1 u 5L ."w` I G W l - - v L' V l' x /
G W • —`_— X
G W X
G W X
G W X
G W - -- X
G W X
G W X
G W _�._ X
G W -- X
Sample Custody Documentation
Samplers Na / m gg� / t ,' 1 i # of Bottles Relinquished b / — # of bottles ) Date / „ a / j _
...1 `<
Print ,..—.)-7-7. i c�' Collected +. Signature • Y r A/ relinquished / Time 9 .G', ,,
Received By: # of Bottles Date / Time f Relinquished By: # of bottles Date /
Print received Received Signature relinquished Time
Received for Lab: ` # of Bottles Date / Time 7 Lab
Signature received Received �` , � ( Comments
Quality Control Data
Date / Time Anal is: At18Jylfcal Method: Sample ❑ Form Incomplete El Non-Coliform bacteria / silt present Approved By:
Colilert TM (SM9223) Flags: ❑ Sample Outside Hold Time ❑ Quantity too great to permit agitation CP i t)2) /
(( n SM 20th Edition ❑ Excessive Chlorine Present ❑ Quantity insufficient for analysis
0 C t 1 / ° Id- ,)'- P 0 1 ❑ Unsuitable Container ❑ Date: g , � 5
Sample Type(s): G - Grab; Sample Matrix: W - Water; Preservation: I - samples iced down 1. Thermometer S /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
i __ Water of satisfactory bacteriological quality should be free from Coliform organisms. I - .-
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 NELAP 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