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Fresenius-LR140124 Water Bacteriology Report/ Chain of Custody Record City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report# LEWISVILLE 897 Treatment Plant Rd.,Lewisville,TX 75057 Monday-Thursday Daspitoorkerretivor.erot hum Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon oI i q Lab ID 48146 EPA Lab Code TX01143 Sam.le Bottle I.D. # EIVIIIII Customer Name: , atu •- - - ° `roject# Customer Address: 0 0 / Project Address: - NIWAIFIMMEN Contact: ity,State,Zip w . a 6 L ,, i 1 woragilim Phone# Phone# Fax# afar System ID# Sample Collection Information Water Sampling Information .o Analytical results Type of Sample Water -,1 Total Chlorine Results Collected Source a¢ Coliform E.Coll ro w a C Q - Sample ID Date Time i rn o N (Point of Collection) Collected Collected a Residual a� E`o E (mg/L) a g N cp K A2J ID©© an■Q�I■■■P/■■■C I X II■■lI■ v' sfar'�■_J l®©© ; r■■VA■■■u■■■■ X ■NIMI■■ MIS■©© ■■■■■■■■■■■ X ■■■■■ . L STa, 23 .S iI®ffl1®©© MIMI■■MINI■ENMINI■ x ■P/■■■ a r cu. a�t. V�i■111■!©© S ■AI■■■PI■■■� x ■ICI■■■ M. ■©© ■■■■■MINI■■•■ X ■■■■■ ■©© ■■■■■MINI■■■■ x ■■■■■ ��■©© ■■■■■■■■■■■ x ■■■■� ■0© ■■■■■■■■■•NI X ■■■■■ ■©© ■■■■■■■■■■■ x ■■■■■ Sample Custody Documentation amplers Name: - #of Bottles Relinquished by: \ ( #of Bottles �1 Date/j MI Print ' v(,LJi :4) 7 q,-,`� Collected ®Signature y L .l !Cy S Relinquished Time , Received By: 6 #of Bottles Date/Time `l 6 Relinquished By: #of Bottles Date/ Print Received .Received Signature Relinquished .Time Received for Lab: p #of Bottles Date/Time (-- ilf Lab Signature 4 V LI Received 111 Received 11; co Ai, Comments r Quality Control Data Date/Time Ana sis: ,Analytical Method: Sample ❑ Form Incomplete ❑Non-Coliform bacteria/silt present Approved By: j_a3_1�� (fir ...' CL CColilert TM(SM9223) Flags: ❑ Sample Outside Hold Time ❑Quantity too great to permit agitation SM 20th Edition ❑ Excessive Chlorine Present ❑Quantity insufficient for analysis ❑ Unsuitable Container ❑ Date: DEMO' Sample Type(s): G-Grab; Sample Matrix: W-Water; Preservation: I-Samples Iced Down; Lab Chlorine Residual: ND-Not Detected, D-Detected 1.Thermometer SIN: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. ® 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