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
E.
coli
1
E.
coli
per
100
mL
Filter
no.
Number
of
fecal
coliform
CFU
2
mL
of
sample
filtered
Analyst
initials
Fecal
coliforms
3
4
RESULTS
Long­
Term
2
Enhanced
Surface
Water
Treatment
Rule
Source
Water
Monitoring
Method
Type:
Membrane
Filtration
Analytical
Method
Number:
SM
9222D/
9222G
(
mFC/
NA­
MUG)

mFC
incubation
end
Fecal
coliforms
per
100
mL
mFC
incubation
start
NA­
MUG
incubation
start
NA­
MUG
incubation
end
Time:
Time:

Temperature
(
oC):
Temperature
(
oC):
Section
1.
Laboratory
Identification
Information
Laboratory
name:
Laboratory
ID:

Sample
ID
(
optional):
Sample
collection
date:

PWS
ID:
Sample
collection
time:

PWS
facility
ID:
Holding
time:

Turbidity
result
(
NTU):

Source
water
type
(
circle
one):
Flowing
stream
(
FS)
Reservoir/
lake
(
RL)
1GWUDI­
FS
1GWUDI­
RL
Date:
Date:
Sample
collection
point
ID:

Temperature
(
oC):
Temperature
(
oC):
Date:
Date:

Time:
Time:

Draft
June
2003
