Barnes-LR100914 OV
Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments Report #
i f 'L S J LE 897 Treatment Plant Rd., Lewisville, TX 75057 Monday - Thursday
� ,t,.roev ar phone (972) 219 -3548 fax (972) 219 -3506 8:00 A.M. - 12:00 Noon cj 1 U.- ZCj/
'Lab ID 48146 EPA Lab Code TX0114311 IISample Bottle I.D. # 1 (.1 n3)
Customer Name /i c , N° ea 4..70V4-.) Project Name: a = R .. - Project#
Customer Address. oc, ,' Z Project Address: A• y r ' / �
City, State, Zip ) City, �� ` ��� S VV , ,,6744/Contact:
Phone #
I � [ ilr „,>5✓(:,/ .e r /t � 5V5 ty State, Zip Cap eta _
Phone # - 7 Za 5` Fax # Water System ID#
Sample Collection Information —” Water Sampling Information Analytical results
Sample ID Chlorine Results Type of
Collected so u Coliform E. Coli -.- (Lab Use Only) d L ` - ¢ @
Sample ID Date Time E a E' _co E 8 a)
(Point of Collection) Collected Collected Z a) Residual o ° a`) ° E
a E E (mg/I-) m E m _ c E U - o - ' o m in
o m m co N o I m fi Q o u, 2 N U s u_ = y 8
—
1 m rn u) (I) I— Li_ I p cc o co U E 3 cn CO E ui u z u z D
)l'" 4 1p `x -13 - 4)ie 1 , ' G W Ir 0 t ■ ■IR■ ; i-" x u'
A 1 G W _—
G W _ _ MIME X
G W _ _ 111111.. X
G W
G W E ■E■■ X
G W EMMEM X
G W ■■■■ X
G W MEM. X
G W MENEM X • t l 1
Sample Custody Documentation
P rinplersName: � � 4 F Tpd,( Colletted I Signaturehedby: k �� ��� relinquished Tme/ -d
jr
Received By: t G (� ` # of Bottles Date / Time Relinquished By: # of bottles Date /
Print received Received Signature relinquished Time
Received for Lab: � # of Bottles Date / Time _
Signature / ✓ ���� received Received �� g Comments
�/� Quality Control Data
Date / Time Analysis: Analytical Method: Sample ❑ Form Incomplete ❑ Non - Coliform bacteria / silt present Approved By:
i Colilert TM (SM9223) Flags: ❑ Sample Outside Hold Time ❑ Quantity too great to permit agitation 7 t' ,"
CI-13- {_ W
, j - - � 0 e �� � � � � SM 20th Edition 0 Excessive Chlorine Present ❑ Quantity insufficient for analysis , �
❑ Unsuitable Container ❑ Date: 0(....\<‘ — ( C.
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
Water of satisfactory bacteriological quality should be free from Coliform organisms. i , A
z 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 - Form