Villas at LV 2-LR121204 Water Bacteriology Report/ Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory
Samples Accepted Customer Comments: t Report#
I.E\VISVI I,I,h, 897 Treatment Plant Rd., Lewisville,TX 75057 Monday - Thursday cA a o (4- 010A L,
Net,rc4ou N•;dvairjts fine,Fiore. Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon 1,2-a- 07
Lab ID 48146 EPA Lab Code TX01143 l� . 1 Sample Bottle I.D. # I I00,t_I;_6
Customer Name: 47/77---r d
Customer Address: ��ef: y ���..- �,d,r �/ 't<�' / /4 S G t � /�¢ U.S ra,� Project#,/ r C ,),. �ar..Q Project Address:
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Sample Collection Information �r Water Sampling Information .� Analytical results
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g Type of Sample Water N
Chlorine Results yp p rn = Total E.Coll N
ca U Collected Source C6 c Coliform ? N
Sample ID Q)
(Lab Use Only) Sample ID Date Time a j O Oc Q LL
(Point of Collection) Collected Collected E >, _ o g n E o
O H o io LAB Residual t o O a
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Arai it Sample Custody Documentation
Samplers Name: I t#of Bottles Relinquished by: J
Print *a.-/ /4 ' ,✓ Collected Signature l j' 7d Relinquished Bottles 3 Date/ /.7- �%- /.:�
l Relinquished Time r.y}t�•Received By: #of Bottles Date/Time Relinquished By: Y
Print # li Bottles Date/ + at.-p ..I,t�
4 , 6),-- Received Received Signature Relinquished Time rt Received for Lab: , f 1 ' #of Bottles Date/Time Lab
Signature Received Received g �^ Comments
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/ Quality Control Data
Date/Time Analysis: I Analytical Method: Sample ❑ Form Incomplete ❑Non-Coliform bacteria/silt present Approved By:
Id._y_�� I P I Colilert TM(SM9223) Flags: ❑ Sample Outside Hold Time ❑ y great to permit egitanoo r l. "n
ooaont too V"F^
SM 20th Edition ❑ Excessive Chlorine Present ❑Quantity insufficient for analysis
❑ Unsuitable Container ❑ Date: 1 - - 1 t,
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
_, Water of satisfactory bacteriological quality should be free from Coliform organisms. ,..„1.0,
Results above relate only to the samples on this report. _,
'T.''''T ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAP unless otherwise noted. ' `I M
w 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. ` o A a„'
Revision 1.5 7/31/2012
Effective 7/31/2012
Page 1 of 1 Bac-T Form