Tax 2011B-LR121031 Water Bacteriology Report/ Chain of Custody Record � I c't,j� 1�'1 Ce V
'City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report#
L,E1.1''ISVILI E 897 Treatment Plant Rd.,Lewisville,TX 75057 Monday -Thursday -Po NOT M 1 — R-6-SwA.7S. .•. W tt—l-
Deep Roots.ervad'Mrgs finght Fue,rc. Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon Y‘a- k.AP I Io - 1)1
Lab ID 48146 EPA Lab Code TX01143
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I Sample Bottle I.D. # 1 10'2t VI-
Customer
Name: C.P 5 C. 0 t I Project Name: JoMra3Elas3c-zDa- T rnPRO6MC 4TS Project#
2.0( 3
Customer Address: t 21 S rESr LArr1E
Project Address: jr Contact: t
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City,State,oZ.ip-f�7 Va�u.'/�1 U I �. T r� 9 rj t3'7 City,State,Zip ati,e� Phone#BO .2�p -3403
Phone# { I2..-t,p,4- 29 So Fax# 972-(074- 295-2. Water System ID# y2 c" 1('‘'.-7771f •
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Sample Collection Information I Q Water Sampling Information Analytical results
Type of Sample Water H m Total �'
Chlorine Results to E.Coli N
'1,121j1 CIK Collected Source m m° Coliform >j i7i
Sample ID e ',r c a a`
Sample ID Date Time a e, � ) c
42 0
(Lab Use Only) Point of Collection) Collected Collected E T q ` ''a > 0 °— `�
3
( ) a a L Residual t a> E
2 ~ g '. s' ` a o a a E
o� : Y C #4,444. (m9/L) a @ ti d fl ._ _ �° Cl)•
O m m It s^y" a3 T.2 m rn 0 O aai m f6 10 8 S LL g L.L. N
_ m v) to -V} }. l .U 12 12 0 v) O W Cl) r ui ti 2 ti z° co
tt ,30 STA Z}%Lc, ■ ' WP-'re,g.. 10.30•tZ 9 t'4o 1 G W i� e 3 VJ ✓
✓ c1 x
. 3) Sr-p I I-F 40 4" w+�- to-30.►Z `t..5-6 `"1 2- G W 3 J ✓ f c6 x )(
G W tsf q , X
G W .. ,, X
G W -�a X
G W X _
G W + a X
G W gY�� X
G W ref Rilii f. I I X
J I G w N x
Sample Custody Documentation )
Samplers Name:/�
--)-1 #of Bottles Relinquished by: //L , #of Bottles Date/1Q_30._I� L.
Print 1 "�r't5 tJ{1/4tL Collected 2 Signature �') Relinquished L. Time ID,of 1 ty`<
•
Received By: l•- #of Bottles Date/Time _Reelinquish #of Bottles Date/ V
Print ^ Received Received Signature Relinquished Time
Received for Lab: 'j 1/, j / #of Bottles Date/Timtt-3 Q.-I4 Lab
Signature ,',Ili/ bA�'' / Received �//,.Received i Comments
Quality Control Data
Date/Tim Analysis: s analytical Method: Sample ❑ Form Incomplete ❑Non-Coliform bacteria/silt present Approved By:
C7 Colilert TM(SM9223) Flags: ❑ Sample Outside Hold Time ❑Quantity too great to permit agitation h j • : 1
�\ I �,. 1 1,,,ttt���
'C -3 L -t 3 1 K j l f ill SM 20th Edition ❑ Excessive Chlorine Present ❑Quantlty insufficient for analysis V '1` .,
❑ Unsuitable Container ❑ Date: \t -11\- Ij...
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
._,77,N, Water of satisfactory bacteriological quality should be free from Coliform organisms. '"`
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 noted. "' ,t
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