Willow Park-LR120321 Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report #
.1.FAVI S \' I I A. ,l, 897 Treatment Plant Rd., Lewisville, TX 75057 Monday - Thursday
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Deep fRoots.8r :we wets.Bnph: Phone (972) 219 -3548 Fax (97'2) 219 -3506 8:00 A.M. - 12:00 Noon 7�/
Lab ID 48146 EPA Lab Code TX01143 I Sample Bottle I.D. # 1 , 3 I).
Customer Name: Project Name: p Pro ect#
Cus tomer Address: '" / Project Address: ,7 / / 4� ,, Contact:
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City, State, Zip , h 5 ' ' / City, State, Zip /� y Phone #
Phone # `,7 -- ' .; -� .3 /,j Fax # Water System 1D# C - /^
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Sample Collection Information Water Sarnpling Information Analytical results
o Type of Sample Water y o Total 0
Chlorine Results E. coil N
U _ Collected Source < Coliform
Sample ID Q
Sample ID Date Time m m c u-
(Lab Use Only) Q x c O °
(Point of Collection) Collected Collected 3 F n LAB Residual ° .0 2 o o , a a-
- n E
m a) a a> Residual (mg /L) Fl m a , Q o . n ca co
° o r ' u 0 as E v o P ° a ° m
O @ a (d 0) N N a N O. O 0) N 't (Q 6 C j c N
CO to m U) H u_ H . Ce CI CO C) , CL u = � H L t z t ° z D
( A S - ( b Aes,4r ,r Jr C,- 3 1L / �, q2 G W ) t,, V - - U V X
(tTi3 04- //'h ; Co G W • / S � _ X
G W X
G W X
G W X
G W X
G W X
G W X
-. G W X
G W X
Sample Custody Documentation
Samplers Name: # of Bottles Relinquished by: : 2 # of Bottles Date / 3 .A t., fl
Print (,_ 7 5r7H q/' / Collected Z Signature _ �l- ,.2�� Relinquished / Time O� 0 l-1
Received By: /! # of Bottles Date / Ti . - Relinquished By: # of Bottles Date / t I r a
Print Received Rec:• • -. Signature Relinquished Time
Received for Lab: _ K # of Bottles Date / Timef , l ! 9 , Lab
Signature \ 1 , U e
R ceived • Received J .7 ma y` �� t � Comments ih V I" G3
Quality Control Data
Date/Time Analysis: // olilert TM Method: Sample ❑ Form Incomplete ❑ Non - Coliform bacteria / silt present Approved By:
CTYC Flags: S am le Outside Hold Time
,`( ` r ( SM9223 ) ❑ Sample ❑ Qua mn y too great to permit agitati ,,t) :L'
3 , _ M1& Q l 0 , 3 0 p l� SM 20th Edition ❑ Excessive Chlorine Present ❑ Quantity insufficient for analysis NA
❑ Unsuitable Container ❑ Date: °) --,14
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
White (Original): Returned to Customer as a report / Chain of Custody record; Yellow: Customer Copy at time of drop off t' 11?';,. nelap Water of satisfactory bacteriological quality should be free from Coliform organisms. � tap
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 no ` � /� ( / r r ,
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 f y � Effective 7/1/2011 need / 19L4 i W eY ` Q' Page 1 of 1 Bac -T Form
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