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Belmont-LR140130 Water Bacteriology Report/ Chain of Custody Record City of Lewisville Environmental Control Services Laboratory Samples Accepted Customer Comments: Report# LEWISVI 897 Treatment Plant Rd.,Lewisville,TX 75057 Monday -Thursday per. vnrs�aen�x Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. - 12:00 Noon �'� ' f f j Lab ID 48146 EPA Lab Code TX01143 I Sam•le Bottle I.D. # =®1111111 ustomer Name: ' 11 - A -roject Name: U r ' Project# t 'c ustomer Address: ' r ," �, 'roject Address: , r c 4M190111, Contact: / ✓ ,' ' 46121.111111M1 ity,State,Zip I i r Phone# • v ce/ ♦ • • , /� - Phone# -_��/Q�i� ater System ID# / at __ -" _✓ 7. Sample Collection Information Water Sampling Information Analytical results Type of Sample Water „ Total Chlorine Results m Q E. N coil y Collected Source N m Coliform > re c m to Sample ID Date Time o m (Point of Collection) Collected Collected Residual I i .n E ta";"" U c iv W. 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ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAP unless otherwise noted. y„ .• 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 Water Bacteriology Report/ Chain of Custody Record . City of Lewisville Environmental Control Services Laboratory Samples Accepted. Customer Comments: • Report# L.ESA ISVILLE 897 Treatment Plant Rd.,Lewisville,TX 75057 Monday -Thursday • Daep RSoU.BroarlYilais.finght ruoue, Phone(972)219-3548 Fax(972)219-3506 8:00 A.M. -12:00 Noon 0(l (^ /1 Lab ID 48146 • EPA Lab Code TX01143 Sample Bottle I.D.# 1 I Q 1 I I?I Customer Name: Project Name: Project# • • r`. •c C. �r�lin r_�nSI-�u�' ol/l (�P1 rnr� n L � nG�i�aj 1 Customer Address: /' y1 IAh Ai Drib' Cr tyro 4,r C.e p rncc t.,T la t4 Project Address: r. 15 trt t% Den Inh r - 1.I Contact: is r r,'' �'t�v, r, city.slate.Zip DAI rL51 75 �f76 �. Ui e TVA "' Cltvstete,Zip C'nrp aII �.+f3( 7 7S0IGfit3� T Phone# ro17.`f 01;6 .1-- IA,$ I •Phone it °I7,2- ? 7/ —431.2% - Fax# ` Water System lD# -Pa t( 017,-2A 6 i'I — R,7n Sample Collection Information ''` ,: Water Sampling Information 1 Analytical results _ 1 4 - o Type of Sample water 2 ,' Total` t Chlorine Results source �' coliiorm E cau ks ro * —Collected � e � Ii-$P UseO lyD Sam le ID Date Time x to . .c f c o m Q O (La useogjy)q .(Point of -.. Collected Collected E .. _ a lw zti a �._. . a • j _.... ._ i ,°' m L Ba •Residual _ _� E- a) 2 c o .o . . .: \a r4P cl'u v r - — —2_11 G t1� n- Reslduel: (mgLL)-— —-A u-.--Ta- -o-- -t°3 —o 'o -m-c - O �,a[g t E Ile q meta ul d ro E o E u_ 2 LE - y . I-` rM l m mi m / s gr ` - o td w o ° to a u) g ui k �i z° m W ' t �'�* rq m ma S t- + ti I--. fl' G co � Q' ' T Sr,, rat tcrt ‘,�cif) 4*-; ►/aq�ly �, G w M I �/ J.P 0 ;S) a.�Jr�:tg-i, S r& rfY r& 1..lsalti ..*^s=sa t- 'r�}�':.r7'rf. G W R1 rg '/ Via/ G.. .. .. J. • t1 7. X v- I w � 7- PYe lere5'S I rl N ? _L li 1`00 .3 mi (; is ..5 ✓ \7 '1< X s/ aIO.grO exeSln-i- tclne X1.1 I--a.4Y--I1 HH•PO G W "'(': A,0 . V V b:R X ✓ [ Lc) r I " X13 � R : N r G w g i x -1 ,rr t r1 C Vim ' G w '':y t .rr rr x rn idk G w "�'t ti� br, x ;�, 4 y A G W st M . X • ,::::::7-agfam ,. ..._v:,...}I „�s V G w ,'z ' .: .,1; .. ..Ir`= per"": X Sample Custody Documentation Samplers Name: f •Boltls Rellnquished by: / #of Bottles Date/ U Print r fed ` Si nature �� Relinquished ,' Time f-� ,i`{ Received By: d� #of Bottles ' Dale I Time Relinquished By: #of Bottles Date I Print Received Received Signature Relinquished Time Received for Lab: #of Bottles 1 Date/Time 1-1Ot-.1 Lab Signature t� �LA\^ Received ICI Received '1, Comments • I\ Quality Control Data ' Date!Time Analysis: alytical Method: Sample i Form Incomplete ❑Non-coliform bacteria 13111 present Approved By: 1�/Colileft TM(SM9223) Flags: ❑ sample Outside Hold Time ❑Quenatyloo areal to permit apltaaon /aP•� t^ �t 1� ' t' V/II l - SM 20th Edition ❑ Excessive Chlorine Present 1:1 Quantity insufficient for analysis ❑ Unsuitable Container ❑ Date: I'1,1'i- i`f Sample Type(s): G-Grab; Sample Matrix: W-Water; Preservation: I-Samples Iced Down; Lab Chlorine Residual: ND-Not Detected, D-Detected 1.Thermtomet•rSIN:61030428 White(Original): Returned to Customer as a report/Chain of Custody record; Yellow: Customer Copy at time of drop off .43',y i Water of satisfactory bacteriological quality should be free from Coliform organisms. yPeC° Results above relate only to the samples on this report. '•� j''. ECSL certifies that all results contained In this report were produced in accordance with the requirements of NELAP unless otherwise noted. `9. ' .';1 6666"". `•w 5' s- 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