Section
2.
Sample
Collection
Information
Section
3.
Sample
Process
Dates,
Times,
and
Temperatures
Section
4.
Number
of
Positive
Wells
and
Calculations
Large
wells
positive
Section
5.
Comments
1Ground
water
under
the
direct
influence
of
surface
water
Large
wells
positive
Long­
Term
2
Enhanced
Surface
Water
Treatment
Rule
Source
Water
Monitoring
Method
Type:
ONPG­
MUG,
97­
well
Analytical
Method
Number:
SM
9223
(
Colilert
®
and
Colilert­
18
®
)

Section
1.
Laboratory
Identification
Information
RESULTS
E.
coli
per
100
mL
E.
coli
Sample
volume
analyzed
(
mL)
Total
coliforms
Analyst
initials
Date:
Date:

Small
wells
positive
Small
wells
positive
Total
coliforms
per
100
mL
Laboratory
name:
Laboratory
ID:

Sample
ID
(
optional):
Sample
collection
date:

PWS
ID:
Sample
collection
time:

PWS
facility
ID:
Holding
time:

Sample
collection
point
ID:
Turbidity
result
(
NTU):

Incubation
start
Additional
incubation
start
Date:
Date:

Time:
Time:

Temperature
(
oC):
Temperature
(
oC):
Source
water
type
(
circle
one):
Flowing
stream
(
FS)
Reservoir/
lake
(
RL)
1GWUDI­
FS
1GWUDI­
RL
Analytical
method
number
(
circle
one):
SM
9223
Colilert
SM
9223
Colilert­
18
Temperature
(
oC):
Temperature
(
oC):

Incubation
end
Additional
incubation
end
Time:
Time:

Draft
June
2003
