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Westhaven 1-LR130710 Water Bacteriology Report / Chain of Custody Record City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report# I,EW I SV I Lj E 897 Treatment Plant Rd., Lewisville,TX 75057 Monday - Thursday 0713- 3/ Deep Roots.ktudWIr a,gr.Fvwo. Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon 07-10- 13 Lab ID 48146 EPA Lab Code TX01143 II Sample Bottle I.D. # I 405/3y Customer Name: Project Name: I �d (lfl(A CcA,S1.1i) _ ion_ WSSfHAvp/Y c' / Project# Customer Address:A v y6 it/nv/L Ge _ ', ,/ _ r, J: Project Address:h),LL,S ,/d De��^� �JFF`contact: City,State,Zip ��( ` A`S V 9 06 ' ' c t. City,State,Zip•Uc;�7 D !I/Gq PP ELVL 1 Phone# Phone#�/ I2... ea• �.` -�� Fax# Water System ID# O5 / o^ /O I , lJ Sample Collection Information Water Sampling Information Analytical results o o I Type of Sample Water o Total N Chlorine Results L Source co 0 Collected a Coliform E.Coll c Sample ID �, N Q ti Sample ID Date Time = (Lab Use Only) ` (Point of Collection) Collected Collected E a . fi w o °- o a m co LAB Residual o a E o a a Residual (mg/L) m " m Q o _ o. E E 0 m 0 o C v - O o 0 o O cs m ca a) � i0 N Q. O 8) N 't a3 m 8 S t S - N c0 C ^`t p/� m Cl) cn In SFr— N �] tt � o: o rn Ud_� � cn (n f° w t° z t° z D � r)MLinW (C /TEp cruQIt? _022/6p42_9:70/� I G w 4 7 NP 2..3 d / „a.°A X ✓ a t4 Y R i � S I ��F o�j/ _Li 4-•�_ ,2 G W 2 3 (4, / •0 1 �•�►) x ✓ , G W X G W X G W x G W x G W x G W x G W x G W X Sample Custody Documentation Samplers Name: #of Bottles Relinquished by. ^ #of Bottles Date/09,fyy) 1 Print Collected Signature a Relinquished Time /Q'V �Or�t c Y��O (2)cis �Osc,� 2- p©tt�l c C1 O Q f�O.Sc,,. Received By: #of Bottles Date/Time e inquished By: #of Bottles Date/ l Print Received Received Signature Relinquished Time Received for Lab: '/ n,_ ^ #of Bott`es Date/Time 7-7IO—1 3 Lab Signature 11- " LV Received 9 Received Comments l r 11 K• i 0:104- _ Quality Control Data Date/Time Analysis: Analytical Method: Sample ❑ Form Incomplete C]Non-Coliform bacteria/silt present Approved By: �� ❑`Colilert TM(SM9223) Flags: ❑ Sample Outside Hold Time 0 Quantity too great to permit agitation t — O— , ,,. �, �, ` SM 20th Edition El Chlorine Present 0 Quantity insufficient for analysis ' 11.1 bb�-''' ❑ Unsuitable Container C] Date: -,l—1 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 4,..,,,,.,,,‘,,,,.,, Water of satisfactory bacteriological quality should be free from Coliform organisms. p'-' ow„ Results above relate only to the samples on this report. Trill ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAP unless otherwise noted. 'Pt Ann,`` 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. m4■o+" Revision 1.5 7/31/2012 Effective 7/31/2012 Page 1 of 1 Bac-T Form