Willow Park-LR120516 Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory
Samples Accepted Customer Comments: Report#
I,I,\.V IS\7I I.,I,I:', 897 Treatment Plant Rd., Lewisville,TX 75057 Monday - Thursday c (I C lc H \I
Dreg Roots.P,rcad iris.8nsh Future. Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon Q. "� .�<- �;
Lab ID 48146 EPA Lab Code TX01143 I j/
J C 1 Sample Bottle I.D. # � LE q (.2 (
Customer Name: CO'Con,.7/ac 4In /� c Project Name:
IN t I v 17 c4 /C Project#
Customer Address: l y D 0 w /7 V_01 9' c d Project Address:
Contact:City,Stale,Zip I y V// *x l '`' 0
ko City,State,Zip co p p l /' ,j X Phone#
Phone# 9 ?2 7 S r.t 3 2,O Fax# Water System ID# �! L.-I I_
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Sample Collection Information n
"It; ' Water Sampling Information Analytical results
Hof°' ,T' I•_ L Chlorine Results Type of Sample Water - Total aCollected Source Coliform E.Coll I
Sample ID s,� �„� �, � a N co
(Lab Use only) Sample ID Date Time 2 �, PEL1 Iv c
(Point of Collection) Collected Collected _ 1p r; � i{ c 0
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Sample Custody Documentation
Samplers Name: #of Bottles Relinquished by: _
Print ��n�C/S /`� a - Ot Collected Signature #of Bottles Dale/ S--(5—_(a..
C� Si nature /'� J C� /4.�� Relinquished oz
Received By: #of Bottles Date/Timer `� 1.( 10,•r /Q0,-1,.
Print Relinquished By: #of Bottles Date/
t
Received Received Signature
/ Relinquished Time
\
Received for Lab: 1 ///'''111 #of Bottles Date/Time Lab
Signature ��, ` �� / Received rl Received �~c� C�”
v�� Q' Comments
Quality Control Data
Date/Time Analyst A alytical Method: Sample
❑ Form Incomplete ❑Non-Coliform bacteria/sill present Approved By:
ati7Colilert TM(SM9223) Flags: ❑ Sample Outside Hold Time ❑Quantity too c_1( /p ,
great to permit agitation �(/ '
S� _( S` t , Ids 0 SM 20th Edition El Excessive Chlorine Present 0 Quantity Insufficient for analysis
��T ❑ Unsuitable Container ❑
Date: V S"-I b - 0--
Sample Type(s): G-Grab; Sample Matrix: W-Water; Preservation: I-Samples Iced Down; Lab Chlorine Residual: ND-Not Detected, D-Detected
F!1.^ r- 1.Thermometer SIN:51030428
� ;:: a .o White(Original): Returned to Customer as a report/Chain of Custody record; Yellow: Customer Copy at time of drop off Lwr ,,
heap ' Water of satisfactory bacteriological quality should be free from Coliform organisms.
�'�ry $
Results above relate only to the samples on this report.g
ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAP unless otherwise noted. F,,he�ap
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. ��WA
Revision 1.4 7/1/2011
Effective 7/1/2011
Page 1 of 1 Bac-T Form