Coppell Ind 2-LR130328 (3) 14-tifotr re b T2"V,( Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report#
LEWISVILLE 897 Treatment Plant Rd., Lewisville,TX 75057 Monday - Thursday (I-i _ ,i'S4 - `i
oeep%MU. adwirp.8rf ^t Future. Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon C !Y .J !
Lab ID 48146 EPA Lab Code TX011431 II Sample Bottle I.D. # I 3 I'):) t
Customer Name: if /� l Project Name:, { t Project#
Customer Address: L -y Project v1 t- z4 y rrr 2/22 0
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Phone# /n. F:3 8 2 8 pp Fax# C 7.L j Water System ID# i f
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Sample Collection Information Water Sampling Information I Analytical results
C Type of Sample Water y S Total
.fi Chlorine Results Collected E.Coli v,
` Source 2 Coliform m
Sample ID
p Sample ID Date Time .a C u) m c — Q
(Lab Use Only) (Point of Collection) Collected Collected E °� a y o —° o �'
m LAB Residual v Cr) o m
m o a a Residual (mg/L) .Q " is N o _ c c m cn
a E E m 3 '`' a0i c o — m v o ° i
O co E c0 07 R o CO rn Q O d a: CO o U 0 o c 0
CO cn cn U) I— u- F- 12 a to U & U) w L Z L� Z
. �`f i ( t ) A l e',1-2 L A. 7-2 -1:3 %,S0 rwm 1 G W ) c jv`t.- ),C \/ ,./ O 011 X
G W X
(- - ) ( N'e . Koie.u.., p --Z7-L3 /f):6'11,,N G W i a# \ 2..,c, `I° f' x
G W I X
G W X
G W X
G W X
G W I X
G W X
G W X
Sample Custody Documentation
Samplers Name: / v #of Bottles q Relinquished by: /` #of Bottles Date/ ,
Print ` r ( t _ 1 0 Collected 1... Signature Li�pu6( C�jf. y�' Relinquished -Time
/�Lt �� 7 t Li r i r,f
Received By: #of Bottles Date/Time 'Relinquished By: #of Bottles Date/
Print Received Received Signature Relinquished Time
Received for Lab: 1 P #of Bottles Date/Time .. �_! Lab
Signature -.� -�v ',/j9,� Received Received ' Comments
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Quality Control Data
Date/Time Analysis: Analytical Method: Sample ❑ Form Incomplete ❑Non-Coliform bacteria/silt present Approved By:
9 Colilert TM SM9223 Flags: t
j ``t ( ) ❑ Sample Outside Hold Time 9 too great to permit agitation 'i
SM 20th Edition ❑ Excessive Chlorine Present ❑Quantity insufficient for analysis
❑ Unsuitable Container ❑ Date: - -
Sample Type(s): G-Grab; Sample Matrix: W-Water; Preservation: I-Samples Iced Down; Lab Chlorine Residual: ND-Not Detected, D-Detected i.Thermometer S/N:51030428
White(Original): Returned to Customer as a report/Chain of Custody record; Yellow: Customer Copy at time of drop off
"lE`°` 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.
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. lo
Revision 1.5 7/31/2012
Effective 7/31/2012 Page 1 of 1 Bac-T Form