DDW-2024-006509

D//‰
PO Box 144830
Salt Lake City, UT 84114-4830
Phone: [phone]
Fax: [phone]
Email: [e-mail]
www,d rin ki ngwater, utah. gov
DR:NK:NG
WAttE資
BACTERIOLOGICAL SAMPLE SITING PLAN
As part of the Revised Total Coliform Rule, the location from which samples are taken is to be varied. All water systems are
required to maintain a current bacteriological sample siting plan. The plan shows the locations of all sample sites from which
bacteriological tests are taken. Sample sites are to be representative of all pressure zones and each water source of the
distribution system. The sample plan should be revised regularly and following any major construction project impacting the
distribution system. For questions about this sample site plan please contact Pete Keers at [phone] or
[e-mail].
MAP OF SYSTEM
Have you enclosed\attached a map of the distribution system showing the source (well, spring, etc.), storage tanks,
treatment facilities, distribution piping, routine sample locations, and follow-up (repeat) map? [ ]Yes [ ] No
it simple ie: gooqle map, GIS drawings not requi,
WATER SYSTEM:NFORMAT!ON
Mailing Address: & F, Ae.' X ?3 ?
SeⅣte Conneclons 3∫O Popda10n SeⅣed: 980
System tt UttAH O λ〔DC)∫
Phone#Jf.or,h'.rnef, Ac
SAMPLE COLLECT10N
Phone #:435- e2|o- /q43 Fax #:
The Laboratory was sent a copy of this plan on:
Water was sent a copy of this
RAW WATER SAMPLING
ls the water continuously treated with chlorine? ffi VfS []NO
Systems, which provide continuous chlorine treatment, are required to take samples of water prior to the addition of
chlorine (raw water samples) on a quarterly basis. Please list below the sources which are continuously treated and the
months when raw water samples will be taken:
Months sampled:
Months sampled:
SAMPLE LOCAT10N‐SSystemt___
The following describes each routine sample location, what months the location will be sampled, and where follow-up
(repeat) samples will be taken in the event of a "positive" routine sample.
Routine Sample Location:
(location name or address)
Description:ιllo N ttZttω
Water samples will be collected from this location during
3.
(location name or address down-stream)
Feb.
May
Aug.
Nov.
Follow‐up frepeat)Sample Localons:
:ご ftX、ヽハ゛
(hose bib, sink faucet, etc.)
lSt Qtr:
2nd Qt「
3rd Q廿:Routine Sample Localon:
ЧワoO ttl `ι lg″
Description:
(location name or address)
S.*\c
(hose bib, sink faucet, etc.)
Water samples will be collected from this location during
the months of (circle):
(location name or address down-stream)
1ま Qtr:
2nd Qt「
3rd QtE
4h Qtr
Jan.
Apr.
」ul.
Oct.
(source)
Follow‐up(repeat)Sample Locations:
(routine sample location name or address)
(location name or address up-stream)
Routine Sample Location:
Ytrc*- v: LO67 U' (locationnameoraddress)
Description: S,* \<
(hose bib, sink taucet, etc.)
Water samples will be collected from this location during
the months of (circle):
Follow・ up(repeat〕Sample Locations:
1.
(routine sampb location name or address)
2 .{ aook} 6'l l0 \l
(location name or address up-stream)
(location name or address down-stream)
lSt Qt「
2nd Qtri
3rd Qlr:
4h Qt「
」an
Apr.
」ul.
Oct.
(source)
Report prepared o'v, /$-^ &2il A /LowJs system +: Olen/
S卯 如Ю ttd Ⅷα 助じ
3¶ιらoω ιO b M
ISAMttE LOCAT10NS
Svstem#:
The following describes each routine sample location, what months the location will be sampled, and where follow-up
(repeat) samples will be taken in the event of a "positive' routine sample.
Rou∥ne Sample Localon:Follow・ up(repeat)Sample Locatio■Ql
l.
(location name or address)(routine sample location name or address)
Description.
(hOSe bib,Sink faucet,etc)
Water samples wi∥be collecled from this localon dunng 3.
the months of(cirCle):
1盤 Qtr: tah`‐ Febl l Man ‐ 4.
2nd Qt「 Apr. May Jun.
3d01E IJd.| ■Auo l〔野.|:
40 Qt● Oct. Nov. Dec.
(location name or address uPstream)
(location name or address down-stream)
(source)
Roulne Sample Localon:Follow・ up(repeati Sample Locations:
1.
(location name or address)(routine sample location name or address)
Description:2.
(hOSe Ыb,Ы nk faucet,etc)
Water samples w∥l be∞∥ected from this localon during
the months of(cirCle):
(location name or address up-stream)
3.
(location name or address down-stream)
lSt Qtr: 」an.Feb. Mar.
2nd Qt「
3rd Qlr:
4h Qtr
Apr
」ul.
Oct.
May
Aug.
Nov.
Sep.(source)
Dec.
Rouune samp:e Location:Follow"up(repeat)Sample Locations:
1.
(location name or addrass)(routine sample loca$on name or address)
Description:2.
(hose bib, sink faucet, etc.)
Water samples will be collected from this location during
the months of (circle):
(location name or address up-stream)
3.
(location name or address down-stream)
lSt Qtr: Jan.Feb, Mar.4.
2nd Qt「
3rd Qtr:
4h Qt「
Apr.
」ul.
Oct
May 」un
Sep.
Dec
Au9.
Nov
(source)
4.
SAMPLE■OCバ T10NS
Systenや、
The following describes each routine sample location, what months the location will be sampled, and where follow-up
(repeat) samples will be taken in the event of a "positive" routine sample'
Rouune sample Localoni Fo:lowⅢup(repeat)Sample Locations:
1.
(location name or address)(routine sample location name or address)
Description:
(hose bib, sink faucet, etc.)
Water samples will be collected from this location during 3'
the months of (circle):
(location name or address up-stream)
(location name or address down-stream)
1蒻 Qtr: 」an. Febi‐ ■ Mar.
2nd Qt「 Apr May Jun.
3rdOI: | |む l: |‐ ハuO■ I SOわ:41h Qtr Oct Nov. Dec.
4・
(source)
Routine Sample Location:Fo∥ow・ up frepeat)Sample Localons:
1.
(location name or address)(routine sample location name or address)
Description:2.
(hOSe Ыb,gnk fau∝t etc)
Waler samples w∥be collected from this localon dunng 3
the months of(cirCle):
(location name or address up-stream)
(location name or address down-stream)
1駅 Qtr: Jan. Feb. Mar
2nd Qt「 Apr. May 」un`
‐3rl Qtri ,vi. Avg■ 警o
4h Qtr Oct Nov Dec
(source)
Routine Sample Loca∥on:Follow‐up frepeat)Samp:e Loca∥ons:
1.
(location name or address)(routine sample location name or address)
Description:2.
(hOSe Ыb,Ы nk faucet,etc)
Water samples wi∥be collected from this iocalon dunng 3.
the months of(cirCle):
lSt Qtr: Jan. Feb. Mar. 4.
2nd Qt「 Apr. May 」un.
3rd Qlr: 」ul・ Aug. Sep.
4h Qtr Oct Nov. Dec
(location name or address up-stream)
(location name or address down-stream)
(source)
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