Gateway BP(2.5)-LR140115 Water Bacteriology Report/Chain of Custody Record t 1 t r�r..l t
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'City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report#
�i , . 897 Treatment Plant Rd., Lewisville,TX 75057 Monday- Thursday _
Phone(972)219 3548 Fax(972)219 3506 8:00 A.M. - 12:00 Noon �?J I y- S 3
Lab ID 48146 EPA Lab Code TX01143 J I) Sample Bottle I.D. # J 2,
Customer Name: C-'41-44'9044-40+� ^s t`,Q�c,:on ` Project Name:�����R n i �a`�Q�f
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Customer Address: o�/3 g ejQL[{�4 !>ae�`�� Project Address: contact'D SO ��✓t{f �i�2Z�OR DEnni5 ,,9 ,ie43
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Sample Collection Information Water Sampling Information ( Analytical results
Type of Sample Water y Total N
Chlorine Results Coliform E.Coll T N
Collected source
Sample ID Date Time a �, c ¢ L'cd
(Point of Collection) Collected Collected E 0 o ° L E a cc 0
m Residual
:. v ty o a a E
N a (m9/L) a is A U° - o ' ro rn
E E y m 1 17, �i c r — m E — o LL c ii of
= O a m y o t0 H G O d a� c0 o CJ o 0 o C N
)1"v,o e,v .l-�i ve_ s. /-/4 /� // �o G w a.s 'J ✓-- x f
/.JR#4n�c 4-elf" �Ri -/�`/� l/;ei C / G W s' v �7A x V
�:.. G W
X
Tv l .
G W x
G W x
G W X
G W X
G W X
G W X
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Sam stody Document 'Q/)n
Sampler4)Enetr sName: k of Bottles Relinquished by: / (/tom-�'C��onG #of Bottles 9
Date/1-I _ a( a�•Print S KI PLs Collected y� Yl � fJ�'Time I r, ,�y: lL•��� #of Bottles Date/Time !//x Relinquished By: #of Bottles Date/
Print Received Received Signature Relinquished Time
Received for Lab: I #of Bottles Date I Time 1_14- 4 4� Lab
Signature 1� �� Received Received I\ Comments
bb �J Quality Control Data
Date/Time a sis: nalytical Method: Sample
Approved B :
� � ❑ Form Incomplete 0 bacteria/silt present tt�� pp y
I _ �, �., at, rn
Colilert TM(SM9223) Flags: ❑ Sample Outside Hold Time ❑Quantity too great to permit agitation kA',
SM 20th Edition ❑ Excessive Chlorine Present ❑Quantity insufficient for analysis b
❑ Unsuitable Container ❑ Date: 1- 10- 17
Sample Type(s): G Grab; Sample Matrix: W-Water; Preservation: I Samples Iced Down; Lab Chlorin - : N �t Detected, D-Detected 7.Thermometer S/N:51030428
White(Original): Returned to Customer as areport/ of Cu d record; el Custr er Co',.- i; of drop off
Water of satisfactory acte jeh y houl a eeffrom oli�rm •rrr isms.
' ;) R v re ate o y to a mples on this report. ''
ECSL certifies that all results contained mu this repo r produce in accordance with the requirements of NELAP unless otherwise noted.
, :;. This report is intended for the sole use of the cstom- om the work as performe and must beereprodu d, ithout modification,in its entirety. -`T
Revision 1.5 7/31/2012 � /J� �/` /
Effective 7/31/2012 f``� es (f /
Page 1 of 1 Bac-T Form
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