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
Number
of
total
coliform
CFU
3
RESULTS
Total
coliforms
per
100
mL
1
Filter
no.
E.
coli
per
100
mL
mL
of
sample
filtered
Total
coliforms
4
2
Long­
Term
2
Enhanced
Surface
Water
Treatment
Rule
Source
Water
Monitoring
Method
Type:
Membrane
Filtration
Analytical
Method
Number:
EPA
1604
(
MI
Medium)

Turbidity
result
(
NTU):
Section
1.
Laboratory
Identification
Information
Laboratory
name:
Laboratory
ID:

Sample
ID
(
optional):
Sample
collection
date:

PWS
ID:

Time:

Temperature
(
oC):
Date:

Time:

Temperature
(
oC):
Sample
collection
time:

PWS
facility
ID:
Holding
time:

Analyst
initials
E.
coli
Sample
collection
point
ID:

Source
water
type
(
circle
one):
Flowing
stream
(
FS)
Reservoir/
lake
(
RL)
1GWUDI­
FS
1GWUDI­
RL
MI
medium
incubation
start
MI
medium
incubation
end
Date:

Draft
June
2003
