Red Hawk-LR111228 Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: � +, Report #
, \'� ,T. . 897 Treatment Plant Rd., Lewisville, TX 75057 Monday - Thursday U oy1 01 0J P�e�' � -
c e lc .d r x er,,r,F Phone (972) 219 -3548 Fax (972) 219 -3506 8:00 A.M. - 12:00 Noon 1)-11- q /
Lab ID 48146 EPA Lab Code TX011431 11 Sample Bottle I.D. # 1 { is I//
Pr ojec t N P
Customer Name: -` A '� R ,� f� L�J A ij � i
�./� 9 /� {� Project Address: �] { t om - ' / �� % 1 ,p J � , �j�Q��7 i, �/..... 1
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Customer Address: t � � 5 � � Llf l�67lN ��s-Qc An /,� f- 'i't���l, )�n�'5a � 1 (1'�, 1 _fie Contact: / ��. �( r .�-/ �� � � /� � 1 ~�� f
City, State, Zip T t S f . --- Pc 6 g 0, "S' ` City, State, Zip /L C7 / /,r} L /4 � 7 7 tyt P hone # AL. ,/ oe ( ' � 9
Phone # -f 7..- !Q-o - Q� $ -o ,,, :? Fax # R2 1� (�],.f} � "Q Water System ID# J //t
V `r Sample Collection Information �7` 1n T z�+ g Water Sampling Information 1 Analytical results
1 I
N N
T ype of Sample Water Total
Chlorine Results to r E. Coll N @
II 11
. C6 Collected Source � ¢ � Coliform N
m
Sample (� Sample ID Date Time .a m T v s= — _ o
(Lab Use Only) (Point of Collection) Collected Collected E - `
3 F c o `n
m �- 2 LAB Residual E
Z a (a> Residual (mg /L)
a m ;� n o 0 0 �° (')3 a _ 0 0
E a ,E E v m m v o
O c m as 0) co N o f rn O. O d (6 o U o 0 0 o c N co
m co (0 1 — u_ H C C co U cG cn (/) t– uJ u z u_ z D
1 1 t v c r)
�ei,rJ p Riili Zj,2 7 12—P-// /o4" i G w V,_ 'r f�, '.
, v.' J /4 X
I lc/47 O X Fa f 1) P /, s Gt o& 13- /1/ /o,60 a.., G W I ,.ice / r e; /4)4 X 1/.
( 2 _ w As l l iN 6 i- e+J Ce9 v l; Cy. /1 y2$ -6f A9 e° 3 G W ,-- i e V" 4;,,, x f
G W X
G W X
G W X
G W = X
G W X
G W X
G W X
Sample Custody Docu -ntatio _`
Samplers Name: # of Bottles Relinquished by: / # of Bottles Date / ju2 _�(_ Jt
Print '' Collected Signature iv � �i., i Relinquished Time
Received By: # of Bottles Date / Time 'el :uished By: # of Bottles Date /
Print Received Received Signature Relinquished Time
Received for Lab: ///'''��� # of Bottles Date / Time ] + p Lab �-�'
Signature
C -` Received ') Received 1 �c 2& 1l Comments ,.— ,
Qual ty Control Data
Date / Time Analy ' Analytical Method: Sample ❑ Form Incomplete / ❑ Non - Coliform bacteria / silt present Approved:
LiJ J GOlilert / TM (SM9223) Flags: ❑ Sample Outside Hold Time / ❑ Quantity too great to permit agitation y p f �
( X `� &�. /� T! SM 20th Edition ❑ Excessive Chlorine Present (`{/ ❑ Quantity insufficient for analysis V
1 1 1 ) - `, 3,3 P ❑ Unsuitable Container ❑ Date: 11- h i,Ci ..
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
e ,,,;','44t, , White (Original): Returned to Customer as a report / Chain o'TCu5To�y re roc d; Yellow: Customer Copy at time of drop off :4 ,
n „ �� V/ater of satisfact bacteriological quality be free from Coliform organisms. _ <)
( Results above relate y to the samples on this report.
`, EC certifies that all results contained in this report were produced in accordance with the requirements of NELAP unless otherwise noted. ' ' ''' .t.. - '
This report is intended for the sole use of the customer for wh• e ••`rk was performed nd must b reproduced, without modification, in its entirety.
Revision 1.4 7/1/2011 ,/ ,y / / P � f 7 Effective 7/1/2011v 3 ` Page 1 of 1 Bac -T Form