Signature-LR121009 Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report#
LE\VISV%II,I_.E 897 Treatment Plant Rd., Lewisville, TX 75057 Monday -Thursday f
Delp Roots.8rOad'Alms.Brtgh<Fuare Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon I L�I� -
Lab ID 48146 EPA Lab Code TX01143 I II Sample Bottle I.D. # I I C h).R I
customer Name: 14.S -(_,,,_ 2g. 7 l �,,,,, Project Name: Project#
Customer Address: -� \�.. \_ P "� ��� Project Address: ` �� I �u'�1f"^
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phone# m c_ _ 3 -"r--1— -2-1 -1 Fax# Water System ID#`5/^'(✓� C W.
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W Sample Collection Information " `s Water Sampling Information
0 Analytical results
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Type of Sample Water Total
Chlorine Results n T^
Z.' U Collected Source (B m Coliform E Coll m
Sample ID a
(Lab use only) Sample ID Date Time s � Q ,�
(Point of Collection) Collected Collected g F_' m -LAB Residual °- 5 o n
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Samplers Name:, Sale Custody Documentation '
print ]] #of Bottles Relinquished by:
(v(_i L o l t �y-Z Collected - Signature
9 of Bottles ? Date/10.4_1A {��j
Relinquished Jv, Time , t
Received By: 9 of Bottles Date I Time Relinquished By:
riot #of Bottles Date
.+ Received Received /" '"'\ Signature Relinquished Time
Received for Lab: _) I` ,p, , t #of Bottles Date/Time(U r{44.,t?I f (� Lab
V CJt - - '� - - • IA;Ilrl nr,mmantc
•uality Control Data
Date/Time Analysis: /Analytical Method: Sample
❑ Form Incomplete El Non-Conform bacteria/silt present Approved By
lait Colilert TM(SM9223) Flags: ❑ Sample Outside Hold Time ❑ouanrty too Teat to pern,n agtanon '/1 /
0 —CI_�✓`` r 1 ►1/ SM 20th Edition {t( !
,� (� ❑ Excessive Chlorine Present El insufficient for analysis '\ U U <°'
❑ Unsuitable Container ❑ Date: )(,) ,-16 -_' v
Sample Type(s): G-Grab; Sample Matrix: W-Water; Preservation: I-Samples Iced Down; Lab Chlorine Residual:ND-Not Detected, D-Detected 1.Thermometer SIN:51030428
White(Original): Returned to Customer as a report/Chain of Custody record; Yellow: Customer Copy at time of drop off
,„„,,,,...7�o Water of satisfactory bacteriological quality should be free from Coliform organisms. , a«d<�
Results above relate only to the samples on this report. 1$ _P
ECSL certifies that all results contained in this report were produced in accordance with the requirements of TNI unless otherwise noted.- 9
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 1.5 7/31/2012
Effective 7/31/2012
Page 1 of 1 Bac-T Form