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Amberpoint 2R&3R-LR130726 Water Bacteriology Report/ Chain of Custody Record City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report# L., , x.7 Y L �, .,1.'a 897 Treatment Plant Rd.,Lewisville,TX 75057 Monday -Thursday ( '3rdtiwGr• tI(U : oee Rotrcs. wrrxs.ertgl-tRwe. Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon 2 "• �J7- C� Lab ID 48146 /� EPA Lab Code TX01143 Samp a Bo. le I.D. # Waraill ustomer Name: •S_ S.. B , C- - c roject Name: n �/ /•„`/O n-roject• ustomer Address' Irk �_ �, - 'roject Address: $6 O�,r.. ,D, b et Q S Z S/ Pity,State,Zip 0O i ,6 p i , ( ' Phone##7Z•- o - 6:,8 ity,State,Zip A sr �.L^ Phone# 2)4- ,6 7o Fax# �f t,l, a',, - t o at System ID# , Sample Collection Information Water Sampling Information . Analytical results I Type of Sample Water y Total ,:., 'R,A4,';11s1)1,1; 77,,.........,' n Chfbhne Results E.Con N c a3 Collected Source @ ¢i Coliform ?�y t7,z,,mi 7:::: Sample ID Date Time o (Point of Collection) Collected Collected Residual o a N E ,w�avw � �fn u.; G7 /k� ,o: !.1��© z-s ■!►■■.1101.■■� X ■�ligII r� +8 ` - E1� c� ro; 11�© z,> ■1�J1.■■i3■■■ gs x ■.1.11.■ ,, - zZt6z t..til, w-1 �R.�®wig© Z•> ■ ■■ �5 X ■1�191�1.♦ 6TA ) 74.16 LN. .1- G q'� to: zo r laM© ■■® X ■.1II1.■ ■0© ,, ■■■■■■■■■■■ X 1.1.1.■■ , g d ■1� ■0© ■■■■■■■■■■■ X .1.1.1.1■ Mill��t ' � 1��■OO ■■■■■■■■■■■ x ■■■■■ �i�!J III l,.aita Aivir■rmm0© ■■■■■■■■■■ x .1.1.1.1 : a�il�:t�`li��i'i ;\��1�1�►n��■�© ■•■■■■■■■■ X .1.1.1.1■ , e r�i►�miti��u� ■o© ■■■■■■■■■■ X ■■■■■ , ' Sample Custody Documentation -' f-,, amplers Name: /�,� rr /- #of Bottles • -.. #of Bottles Date/ gyp ;?; Print (R"(A,t4p + • •S [ Collected �� Relinquished II n Z MI#ec ivttles .Date/Time Relinquished By: �� #of Bottles .Date/ Received Received • 7_Z-t„ Signature Relinquished Time Received for Lab: #of Bottles Date/Time "} Lab ignature `-� Received Received B i,. Comments simerimmimi Quality Control Data Date/Time Analysis: analytical Method: Sample ❑ Approved B ❑ Form Incomplete Non-Coliform bacteria/ present PP By: Colilert TM(SM9223) Flags: ❑ sample Outside Hold Timn ❑Quantity too great to permit agi[anon - MIMI �C i` 6 SM 20th Edition ❑ Excessive Chlorine Present ❑Quantity insufficient for analysis ❑ Unsuitable Container ❑ Date: ■-,y._;-; t, - 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. Fl Results above relate only to the samples on this report. a:m 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. Revision 1.5 7/31/2012 Effective 7/31/2012 Page 1 of 1 Bac-T Form