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Westhaven 1-LR130703 Water Bacteriology Report/ Chain of Custody Record City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report# 1.E\V1 S\71 L1.E 897 Treatment Plant Rd., Lewisville,TX 75057 Monday - Thursday Deep Poou.e cedvnrts eve Faaes. Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon (i1(13_U Lab ID 48146 EPA Lab Code TX01143I Sample Bottle I.D. # I n 5-517) Customer Name r t I9tA4 CO L L Co 0 4)((' C.t ) A/ Project Name: f Project#tvii Customer Address: 6y / 2 i/,yy Gen -„�_ ` L'Qr n1 P-S Q x ib ��L . , r, l 0' c. Contact: / 1-L-L-Q�b1- {K�e Project Address: City,State,Zip ■ _ ! • ' t • d City,State,Zip G; o CQ P r e LL Phone# Phone#9 7- �- , i - "' 3? .3 Fax 4 Water System ID# Q c .009 Q 9 7 Sample Collection Information 7 Water Sampling Information I Analytical results C Type of Sample Water Total `n Chlorine Results as Collected Source Li) Q Coliform E.Cali .T- Sample ID `° Sample ID Date Time m 0) ;v C Q LL (Lab Use Only) J? O (Point of Collection) Collected Collected E a C o o F. m D- to LAB Residual o Eo Z Residual I 7 D y a ° a a (mg/L) m d Q o m ro _ .3 N d ' E U 'o O O O N (B Q) a) R a O N >m 2 ,, �o U s s _ O _ CO (/) (rj CO I— if H c2 E (I) C) Q' > U7 C/) 12 uJ u Z u 2 . ' r. , 0 'MLIMI G W f-- pin vi \/ D.f? x s ORM ' G W OMNI" J V-f3 x 1 V rt —_i : 49 G W RiiiirrIIMEIMIMIlli 'G EMI 4 G W ,,/ ..1).b x ' V _ L /fir L� > G W �. U -i RB x ," / 1 , ,1=• -I HMI_ L; G W G :. C © -O ,( / G w ✓ D.13 x ,� / — p.Q X ■/ o G W X G W X G W x Sample Custody Documentation Samplers Name: #of Bottles Relinquished by: #of Bottles Date I'�—�-_ -- Print J �O Collected Signature G1 t��_r _�t�' V `�) `� OS Relinquished Time `lt !tr 1( Received By: #of 3ottles Date/Time elinquithed By: #of Settles Date/ Print Received Received Signature Relinquished Time Received for Lab: ) - t , 4 of Bottles Date/Time t7.�—/? Lab �Signature _Received Received IV�f IL Comments Quality Control Data Date/Tine Analysis: Analytical Method: Sample ❑ Form Incomplete ❑Non-Coliform bacteria/silt present Approved By: ❑ Colilert TM(SM9223) Flags: ❑ Sample Outside Hold Time ❑Quantity too nh .,J� y great to permit agitation `% '11 �/ _( v I • ' 1( � SM 20th Edition ❑ Excessive Chlorine Present ❑Quantity insufficient for analysis - FYI t L J ❑ Unsuitable Container ❑ Date: }-U-/ 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. Results above relate only to the samples on this report. 2' Mid,. ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAP unless otherwise noted.''' '"�+renoe 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+ Revision 1.5 7/31/2012 Effective 7/31/2012 Page 1 of 1 Bac-T Form