Royal Oaks-LR111103 Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report #
E VIS L
.., 897 Treatment Plant Rd., Lewisville, TX 75057 Monday - Thursday —
Deep koors.8resaVVIng4fit Nu re. Phone (972) 219 -3548 Fax (972) 219 -3506 8:00 A.M. - 12:00 Noon [I (1— rb
Lab ID 48146 EPA Lab Code TX011431 11 Sample Bottle I.D. # 1 IC k 1y,
Customer Name. C%U/V'-f- Cr' 4-4,i it. - .. '• project Name
Z � , y <---. 1 ` a s -i4 X—S Project#
Customer Address: ` c _-, a 7 c y .�, Proje Add , L� .. M j � - ��� -
7 t . / r " I ` ,1R_J` t f l�(.7y Cont�ct:f
1.77 -' n 1 �/ 7 ( l State, Zip C p ` ` 1 ASE . tom..,.._ Phone # ie y
l _
City, State, Zip L ! �7 / ? }/ t'� / City, v, p l_sr j C , �/ L 1L✓ ��� r �" 7e xi ,
Phone # C q .- f i Fax #/ .r , / ? ,12 i 7 1 /, Water System ID# /fit 00 e1'
.� Ic _
' J t
Sample Collection Information Water Sampling Information Analytical results
o Type of Sample Water w Total co
Chlorine Results
t6 Collected Source C6 a Col E. Coli T
To
N
tT
Sample ID
(Lab Use only) Sample ID Date Time • �, x m v c Q
(Point of Collection) Collected Collected E ° ;; Il o ° – E ° °'
m to LAB Residual — L Ti_
0
Z • a fl n Residual (mg /L) 73 Y a o ° m m
r. w y U . e o 0 7
15 to E tE 0) a m 3 G1 C Q — U LL ru N
n m to
CT) 0) f— o co . — CL o d a� / tB
—
— 1 CO cn U F W 0 co V tx (n H uj u_ z _ u_ z D
5 trj 1'7sin; a 6 1 1 1 i�G \/ ; /I/ G W % ` TT V X ✓
G W X _
G W — X
G W — X
G W — X
X
X
X
X
G W —
G W
G W
G W
G W ■
Sample Custody Documentation
Samplers Name: _ # of Bottles Relinquished by: _ # of Bottles s Date / -
Print ' y \ Signature Relin Time t , Collected Si nature i / l �
V � � Relinquished i
Received By # of Bottles Date / Time Relin. ': ed By: # of Bottles Date /
Print Received Received Signature Relinquished Time
Received for Lab: # of Bottles Date / Time ! I — _ ,( w Lab
Signature 4 f , l Received I to. )1*,
Received Comments
K
Quality Control Data
Date / Time Analysis: ] analytical Method: Sample ❑ Form Incomplete ❑ Non - Coliform bacteria / silt present Approved By:
t/ at/Colilert TM (SM9223) Flags: ❑ Sample Outside Hold Time ❑ Quantity too great to permit agitation �-�n/ , ' I A /- "
11 - 3 - 11 iX r• -{ p SM 20th Edition ❑ Excessive Chlorine Present ❑ Quantity insufficient for analysis `� , ' �/y 1�-� ^„
❑ Unsuitable Container ❑ Date: ` '' 1 I - U I 1
Sample Type(s): G - Grab; Sample Matrix: W - Water; Preservation: I - Samples Iced Down; Lab Chlorine Residual: ND - Not Detected, D- Detected 1 Thermometer S /N: 51030428
efr ` 3 White (Original): Returned to Customer as a report / Chain of Custody record; Yellow: Customer Copy at time of drop off 'r '-:%
Water of satisfactory bacteriological quality should be free from Coliform organisms.
Results above relate only to the samples on this report.
»a ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAP unless otherwise noted. 'N_e✓
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 1.4 7/1/2011
Effective 7/1/2011 Page 1 of 1 Bac -T Form