Sales Tax 09-LR101215 (2) t ...
Water Bacteriology Report / Chain of Custody Record (/ 7/
City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments Report #
I.E %VTSVILLE 897 Treatment Plant Rd., Lewisville, TX 75057 Monday - Thursday
c pRmas.arcoav as Nun phone (972) 219 -3548 fax (972) 219 -3506 8:00 A.M. - 12:00 Noon / .,t / y
'Lab ID 48146 EPA Lab Code TX0114311 11 Sample 1 t (d. 1 c `
Sam le Bottle I.D. # I
Customer Name: Project Name. Project#
Customer Address: f• / u f i) i�yU I/rrlr .vrx;d at;k�r Project Contact:
� ,t� roject Address: if ��r�z { C i f
City, State, Zip _ iel - /l y 7......./.34. City, State, Zip `o _ �l t
C ope. " Phone #
Phone # C, 77:1_ ),11......„,26.,2( 1 1 7' !'i4 Fax # � ,..2. Wate —em
Water System lD# �C. 1
Sample Collection Information I Water Sampling Information Analytical results
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Sample Custody Documentation
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Samplers Name: - # of Bottles Relinquished by: _ r # of bottles Date / 1l _ _ Lt.)
Print ' t4 Dec .5.11.5.11.4. �� Collected Signature j �<
' relinquished Time t it'.II'1t-1
Received By: # of Bottles Date / Time '� ' Relinquished By: # of bottles Date /
Print received Received Signature relinquished Time
Received for Lab: n � / A ) f` # of Bottles q Date / Time I d� I I o ti Lab
Signature T �v U / received „/, Received Comments
T �^ N l 1
1 Quality Control Data
Date / Time Analysis: Analytical Method: Sample ❑ Form Incomplete ❑ Non - Coliform bacteria / silt present Approved By:
t l _ �� , C) r L Colitert TM (SM9223) Flags: ❑ Sample Outside Hold Time ❑ Quantity too great to permit agitation D i t
I SM 20th Edition ❑ Excessive Chlorine Present ID Quantity insufficient for analysis ° VV f
❑ Unsuitable Container ❑ Date: , ?, _ t s a l
Sample Type(s): G - Grab; Sample Matrix: W - Water; Preservation: I - samples iced down 1. Thermometers /N: 51030428
E A 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
t ^ Water of satisfactory bacteriological quality should be free from Coliform organisms. V r
�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