Westhaven 1-LR130701 Water Bacteriology Report / Chain of Custody Record
City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report#
I,FAVI S\I I A,At 897 Treatment Plant Rd., Lewisville,TX 75057 Monday -Thursday r 1��
D„,w or:er ed iilro bile,Futvii Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon -0 „
Lab ID 48146 EPA Lab Code TX01143( I Sample Bottle I.D. # I .Z 5-1 )-} `f fj X 31
C , V • . .QA Project Name: 1 " s % 1 1 L . f ose 1 Project#
Customer Name: W C U L IU i
Customer Address: Project Address: . l`, -- U� '00_1\\o n L Contact:
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City,State,Zip bck\ eas A.Y 152.04, S V y}e. Soo City,State,Zip C.4i,At v \� Phone#
Phone# q 7 2 -- q a —Fax N rater System ID# 0 5-1.7 e L-7.-
Sample Collection Information Water Sampling Information I 0 Analytical results
C Type of Sample Water N ~ N
Total
Chlorine Results u) E.Coli u)
@ Collected Source @ ¢ Coliform @ N
Z 0 Q m
Sample IL. 0
Sample ID Date Time a, x 2 o - E ° a)
(Lab Use Only) (Point of Collection) Collected Collected E a `
( ) a H m is LAB Residual u N o -0
-0
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Z m Q Residual (mg/L) R ` m Ti. j m 0
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Sample Custody Documentation
Samplers Name: #of Bottles Relinquished by: #of Bottles Date/ ll
Print Val A > A c ... • Collected �'Signature 6 t � '0 r �0 C G,. Relinquished Time '' /tS r t�'1
It"' _ ► \i YYY 11
Received By: #of Bottles Date I Time Relinquished By: #of Bottles Date/
Print / Received Received Signature Relinquished Time
Received for Lab: I1(I pi ( #of Bottles ^r Date I Time')-I- -) Lab
Signature (, fu Received X Received . n C . Comments
- / Quality Control Data
Date/Time Analysis: alytical Method: Sample ❑ Form Incomplete ❑Non-Coliform bacteria/silt present Approved By:
Flags: 4 ,,kc_ixt.t /
1 ColilertT""(SM9223) 9 ❑ Sample0utsideHoldTime El )
`�"I y ��' J+�� 'n') SM 20th Edition ❑ Excessive Chlorine Present ❑Quantity insufficient for analysis
❑ Unsuitable Container ❑ Date: '1-4.,".r4.-
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 o
,�,p. °Gti`a Water of satisfactory bacteriological quality should be free from Coliform organisms. , G�a
Results above relate only to the samples on this report.
P* 1 ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAP unless otherwise noted.
n„u^' 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