Section
2.
Sample
Collection
Information
Section
3.
Sample
Process
Dates,
Times,
and
Temperatures
Section
4.
Number
of
Colony
Forming
Units
and
Calculations
Number
of
E.
coli
CFU
Section
5.
Comments
1Ground
water
under
the
direct
influence
of
surface
water
Long­
Term
2
Enhanced
Surface
Water
Treatment
Rule
Source
Water
Monitoring
Method
Type:
Membrane
Filtration
Analytical
Method
Number:
SM
9222B/
9222G
(
mENDO/
NA­
MUG
or
Les­
ENDO/
NA­
MUG)

RESULTS
mENDO
or
Les­
ENDO
incubation
start
NA­
MUG
incubation
start
NA­
MUG
incubation
end
E.
coli
per
100
mL
4
Number
of
total
coliform
CFU
Total
coliforms
per
100
mL
Total
coliforms
Date:

Time:

Temperature
(
oC):

Filter
no.
mL
of
sample
filtered
Date:

Time:

1
Analyst
initials
Sample
collection
point
ID:

Source
water
type
(
circle
one):
Flowing
stream
(
FS)
Reservoir/
lake
(
RL)
1GWUDI­
FS
1GWUDI­
RL
Temperature
(
oC):
Analytical
method
number
(
circle
one):
SM
9222B/
9222G
(
mENDO/
NA­
MUG)
SM
9222B/
9222G
(
Les­
ENDO/
NA­
MUG)

Date:

Time:

Temperature
(
oC):
Section
1.
Laboratory
Identification
Information
3
E.
coli
2
Laboratory
ID:
Laboratory
name:

Sample
ID
(
optional):
Sample
collection
date:

Sample
collection
time:

Holding
time:

mENDO
or
Les­
ENDO
incubation
end
Temperature
(
oC):
PWS
ID:

PWS
facility
ID:

Turbidity
result
(
NTU):

Date:

Time:

Draft
June
2003
