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9th Grade Center-LR170713
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 pup R e,-awury.e,r0,cNmm.. Phone(972)219-3548 Fax(972)219-350 Lab ID 48146 EPA Lab Code TX01143 8:00 A.M. - 12.00 Noon ITemperature Correction Factor' l ` Sample Bottle I.D. # Customer Name:r)()jNnA(�/'�L✓ f�y� C G' reject Name: Protect# I Customer Address:'?�D ��` Project Address: �� (�r/1L�2/'✓� � Confect: City, State, Zip (N� "`/ -' We (; L ity, State, Zip 60,pr Zp( I Y Phone 1AL4 (&6 Phone# W Fax# Nater System to# /y(rfnp, 4-4 Sample Collection InformationWater NEE Sampling Information m Analytical Results w 9: m 75 Q or Chlorine Results Type of Sample Water Total B. cell . L� Collected Source :� ¢ Coliform ¢ LL Sample ID Date Time E n lin ° n ti `�'` q,'= E xtr}.:eG llso- 17 ':^ - (Point of Collection) Collected Collected J z T �y - .p d F3 =LesIdual c ° = O .13 ° a = m y n m a ii m id' - n m o � m m io1 CL E ._ oLLO 'o a o :d to w' mTo N '�' O N(d __ tO U M l0 fn t0 1 -i _LL O F ¢ 'a 6 (/J U 3 f� �j li z LL z Co X —POS G W = 4 G W X G W X G W – X "— G W x _ — G W — X x - G W =. X F� G W �-'_ x El Cust dy Documentation Sainple amp am Name: 1� ''/n� rt , �ID 1'1✓r^a I l # of Bottles // Relinquished By: l # of Botlles Date / /rL_ Print 1`1 - 1 Gt. Collected 1 Signature Relinquishetl Tfine . < Received By: # of Botlles Date /Time Relinquished By: # of Bottles Date/ Print Received Received©�'Fl Signature Relinquishetl I ITime Received for Lab: =® '�. # of Bottles ( Date / Time-12diq' q `�"Z-1 Lab Comments Si nature Receivetl Received : V_ Quality Control Data Date/Ti eA�jnalys`is: � �AnalyticalMethod: Sample ❑FormIncomplete ❑Non-Coliformbacteria/silt present Approved By: i tJ el8olile rt TIA(SM9223) Flags: ❑ Sample Outside Hold Time ❑ Quantity too great to permit agitation(in\ SM 20th Edition 13 Excessive Chlorine Present 11 Quantity Insufficient for analysis `_Ry+ Fdl 44 ❑ unsuitable Container ❑ Date: I, I -- I 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. 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 1.6 10/29/2015 Page 1 of 1 Bac-T Form Effective 12/1/2015