Bethel Rd Manor-LR090528
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. Water Bact i 0 IY Report / Chain of Custody Record
City of Lewisville Envlonmentll Control Services Laboratory samples Accepted Customer Comments Report #
~ 897 Treatment Plant Rd., Lewisville, TX 75057 Monday - Thursday ()){/,;. 77-
phone (972) 219-3548 fax (972) 219-3506 8:00 A.M. - 12:00 Noon
Lab 1048146 EPA Lab Code TX01143 ~ ~ ~Bottle 1.0. # o ~ Ci.f tV!.7
ustomer Name: L/ Co-- ~ i(,r '-' { '-C 'j r?ame ?./.!f '{ /<, "L +L.. Co \ proJect# C;(9 r;. J
ustomer Address: L? 3. .:> .3o~ --:::r , ~ (J pc!- ,aJect Address 23 'i J5c. +-L ~ 1 Conlact: ( t,uc.../<- f....p..- h '-
ily, State, Zip 7)~ i I A-"- 'Id- rSL"L =, ~ Slale. Zipl C'l:> pp<--l ( "?(f.... -7 Phone # 2 I Cf 9 7 C. q.-1.7.:s
Phone # 9')'2/ L'f-3>- :5 '+ 5:5 Fax # 772- 2-f.~ '-::;2-2-7 Watei~m ID# ~
: Sample Collection Information ~ 'vvalercSampling Information en "0 Analy1ical results
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0 i~ Type of Sample Water li! .~ en V>
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~ Chlorine Results 1<-::> E. Coli >--
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(Point of Collection) Collected Collected :J I- a.. -"';:"- c .Q a> "C AQ
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Q. E (mg/L) :@ u E "0
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ell ell <11)' Cll 15 III Q 0 Cll " 15 /0 ~ 5en
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Sample Custody Docum
amplers Na~L. ~ ~ k L+-~ # of Bollles I RelinqUished bye e.-h {J c..:=:s--v # of botlles / Dale I S / z <f./ '" i
PrInt ~ '-- Collected Signature relinquished Time r C; /. 'f <
Received By: # of BOllles Date I Ti me RelinqUished By: # of bottles Date I
Pnnt received Received Signature relinquished Time
Received for Lab: '-1{, -1"/ -- # of Bottles I Date I Time 5 -J. ;3 - 0 r..t:.. Lab
lslgnature If A -,.' received Comments
, L::,fC'Vl.<./s.) Received ~ 5
'j)C'1" q.'f5/h.-'
Quality Control Data
Date / Time Analysis: ~alytical Method: Sample o Form Incomplete o Non.Coliform bactefla I silt present ~pproved By:
,..--.. . Colilert ™ (SM9223) Flags: o Sample Outside Hold Time o Ouarlily too great to permit agitation ~ 1 .
~-- ::) <z, - OC(8 \(,\';/f' .-
h 0j ~ ,vI. SM 20th Edition o Excessive Chlorine Present o Quantity insufficient for anal61 i' ...-.; (...,
,~ :...,..' -' l,.(~_
I o Unsuitable Container o "J Date: ~ - .t.'l d~; r,
Sample Type(s): G - Grab; Sample Matrix: W - Water; Preservation: I - samples iced down 1. Thermomet,e(s/N I0304ia'~ 1, Oi
White (Original): Returned to Customer as a report / Chain of Custody record; Yellow: Laboratory Copy (File Copy); Pink: Customer CoPy ~ijfi drop off , Z 0,
. Water of satisfactory bacteriological quality should be free from Coliform organisms. .',
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C t1 yf""Y'(J (, "l", ( , ~ JI'l Results above relate only to the samples on this report. (J J 7
I j IV VV'. Ic L certifies that all results contained in this report were produced in accordance with the requirements of NELAC unless otherwis(rl~ I
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Bac-T Form
Water B
City of Lewisville Environmental Control Services Laboratory
bDtm 89:;~~:t~;~; :~~~~~:~ L~:S(~~:; :~ ::~~~
Lab 1048146 EPA Lab Code TX01143
ustomer Name: C v '" L c - S f{r oJ (C-C ~
Customer Address: 2:/ 3. c) ) O~ -:::r, c. I J E c!-
7)A II A:-"> ---w.. ., S L -z.... =,
")'2/ 2...<f-3> - 5'+5'5 Fax # 772-
acteriology Report / Chain 0
Samples Acceptea
Monday - Thursday 65(fj.. 71-
8:00 A.M. - 12:00 Noon
~ _____ Salnpl~ Bottle I.D. # 0 a c 'f ocr (}
reject NaJlll!!: 2 2/f R c;o.. +t... Co / Project# '79, }
roject A1 ress/.L 3> <{ J5c.. +L c.-- / Contact: (..... ~ v c.../< f....p.._ h '-
~itY,State~1 C<bPPc-(( ;;;r.,t... Phone#2/~ 97C. GO..75
~ater Syst D# ~
ity, State, Zip
Phone #
Sample Collection Information
2-f.';) <>2...2-7
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III
Sample 10 Date Time .0 Q) .~
E 0.
::J >- ill
(Point of Collection) Collected Collected I-
z Q) ~
III Ci Q)
E E Q.
E
0 <11 ell
CD en en
G W 12
G W
G W
G W
G W
G W
G W
G W
G W
G W
Sample Custody Docum
I Relinquishedby/" P 0 ~V ,
Signature '-- \" ..;., --dr- A
Date! Time Relinquished By: /'.,
Received Signature
# of Bottles I Date !Time 5 -J. '8 - 0 ~ Lab oJ V'
received Received I'-- 'A.d .' Comments
5~~~'t~q.1f~
Quality Control Data , ,
Sample 0 Form Incomplete 0 Non.Coliform bacteria! silt present ~pproved By:
Flags: 0 Sample Outside Hold Time 0 Quantity 100 great to permit~agitatlon d( I \)) !L'( \~
o Excessive Chlorine Present 0 Quantity Insufficient for analy - ,
o Unsuitable Container 0 Date: ~ - J... q ,( n
Sample Type(s): G - Grab; Sample Matrix: W - Water; Preservation: 1- samples iced down 1. ThermO':'.7f!~10304~' . ~ ()
White (Original): Returned to Customer as a report 1 Chain of Custody record; Yellow: Laboratory Copy (File Copy); Pink: Customer Cr~ ~ i of lfrop Off~' ? 0
Water of satisfactory bacteriological quality should be free from ~oliform organisms. ,..~, rJ 0 '
Results above relate only to the samples on this report. I r j ~
ECSL certifies that all results contained in this report were produced in accordance with the requirements of NELAC unless othe~Sj~ rJ:. ecr.
This report is intended for the sole use of the customer for whom the work was performed and must be reproduced, without mOdification\J~ts ~tire .
Revision 1.3 3/3/2009 Page 1 of 1 Bac- T Form
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;nalytical Method:
rnI Colilert ™ (SM9223)
SM 20th Edition
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f Custody Record
Customer Comments
"'Water Sampling Information
Chlorine Results Type of Sample Water
Collected Source
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