Section
2.
Sample
Collection
Information
Section
3.
Sample
Process
Dates,
Times,
and
Temperatures
Section
4.
Number
of
Colony
Forming
Units
and
Calculations
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:
EPA
Method
1603
(
Modified
mTEC)

RESULTS
modified
mTEC
incubation
start
modified
mTEC
incubation
end
Time:

E.
coli
4
E.
coli
per
100
mL
Number
of
E.
coli
CFU
Analyst
initials
mL
of
sample
filtered
3
2
Filter
no.

1
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:

Sample
collection
point
ID:
Turbidity
result
(
NTU):

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

Temperature
(
oC):
Date:

Time:

Temperature
(
oC):

Draft
June
2003
