Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Sales Tax 09-LR101217 (3)
CA Water Bacteriology Report / Chain of Custody Record City of Lewisvflie Environmental Control Services Laboratory i amp es ` ...I' - r e • Customer Comments Report # w ' I_EI•VIWILLE 897 Treatment Plant Rd., Lev�isville, TX 7505 I Monday - Thursday Cap Iran 9rawfwhis ptione (972) 219-3548 fax (972)219-351W 8:00 A.M. - 12:00 Noon /00 ° -4 / 1 )...ab ID 48146 EPA Lab Code TXO1143J „ _ ... ' *tn e. r` Sample Bottle 1. Cl. # 1 t 1 l t f. S"• 4/ V f t „ A_,r4.,./ -5„) . (0-c3 • -• Address: cmtact: .Sri'+ ir `tr• Stale. e ref >t N -din. . 7500C [ • . State, Zip mates �y - . _ * • , - _•,..., / ,, t Fax .. - - afar m 9fsfe IDM f�-t :' I ' SCi �O ' -I ��- 1 Sample Collection Information Warr Sa Ir I ^� I , tmp ' .. Information 1 rem - -' r . Res l Type of Sample Water W LO I Collected 1 Sauce . h Sample IO [late Time r I y o m a (Point of Collection) Cdlected Cdlected I. l '. € 94 7L t J ' U5 a ui m GO r lb' b 13� fi1 :3 4i -INS rI ►NN IIH X3 x 11E41111-1111 -3- IIIIIIIIII 114 - M - 7 NININNIIIIIIIIIIIIIM x 1111111111111111 _J M=E • 1E1 Wk. M' 11111111111111111111111111111 IN x 11111111111M -._-_._:__-- IIIIIIMIIIIMIINININNIIE 11N121113 El 6* MINIM E111101.1. MN MI NM 111111111 IN IN11111 IN x N1101 i ©© ■■ ■ENNE ■■ NUM NUN 1 1•1131 WI _ •• ••••. w ■I ■■ MN' � :i mo i x more Sample Custody documentation Sa^PlwsFlame: i "S Collected M ofBotttes Rernquisitedby: u7 mt � t rt° :Sin :- severe ,,fir / : —�— • relinquished ` Tim E -(b -(a � °� imv�ed By: tI) M at Battles Date 1 Time t? . �� bIrmt (wished Ey M of bottles Date ' Received rot Lab- received Receive:I : Date ( Time !l Signature reWtq� ed r C-- J Signature I I f d aRattles 1 ' recei � I Received ' yt � -(� +.' l.�t C•1 i - � I 0 . s . 1'a � CI �- Quality Control Data Date ! Mime atysis: ple alylical Method: Sam ❑Form Irnzrtplete ❑ Ncn- Cdifi7rin bacteria r sit present Approved By: * Colilert 14 (SM9223) Flags: ❑ Semple Outside Hdd Time 0 Quaca9y trio greet ID permit agitation " '4{' ( '..� C., 7) th A SM20thEdIUOdI © E�ooessi.'eCJlomePrrlseerrt I.� O.iarkityirsvfficient ict arrays r '' l .. ❑uruuihableContainer ❑ Date: )- --k - 1G I � .p 4 p e Types): G - Crab; Sarnµle Matrix: W - Water, Preservation: I - samples iced d o w n TJrormemeter sNs st 030423 OM 2. White (Original): Returned to Customer as a report 1 Chain of Custody record; `fellow Laboratory Copy (File Copy; Pink: Customer Copy at time of drop off `. . s _ ti Water of satisfactory bactetbologicat quality should be free from Colifo m organisms r- , Results abov relat only to the samples on this report. --1 ECSL certifies that all results writs/tied in this report were produced it accordance with the requirements of NELAP unless otherwise noted L. � . Tres report a intended for the sate use at the customer for whom the work was performed and must he reproduo i, without modtfteation, in its entirety, Revision 1.3 3. +312009 qi0'.-- Page 1 of 1 8ac-T Form M911 � ( (,/k Oc„,/