DDW-2024-006533

BACTERIOLOGICAL SAMPLE SITE 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.

WATER SYSTEM INFORMATION
System Name: _______________________________________________ System #: UTAH[ ][ ][ ][ ][ ]
Street Address: ______________________________________________ Phone #: _________________
Mailing Address: ____________________________________________ Email: ___________________
Service Connections: ___________ Population Served: _________

SAMPLE COLLECTION
Samples collected by: __________________________________________________________________
Name of Laboratory: ____________________________________________________________________
Mailing Address: _______________________________________________________________________
State Lab Code: ______________ Phone #: ____________________ Fax #: ____________________

The Laboratory was sent a copy of this plan on: _______________________________________________

Utah Division of Drinking Water was sent a copy of this plan on:___________________________________

Seasonal Systems
Is the water operated seasonally? [ ] YES [ ] NO

Dates of operation: Open:________________________ Close:______________________________________

Systems, which operate seasonally, are required to take an investigative sample prior to opening to the public. Where
will that sample be taken?
Location_______________________________________ Date sampled: _____________________________

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
PO Box 144830
Salt Lake City, UT 84114-4830
Phone: [phone]
Fax: [phone]
Email: [e-mail]
www.drinkingwater.utah.gov

SAMPLE LOCATIONS
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: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.
Routine Sample Location: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.
Routine Sample Location: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.

Report Prepared by: ___________________________________________________________________

Signature and Title: ______________________________________________ Date: ______________

SAMPLE LOCATIONS
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: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.
Routine Sample Location: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.
Routine Sample Location: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.

SAMPLE LOCATIONS
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: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.
Routine Sample Location: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.
Routine Sample Location: Follow-up (repeat) Sample Locations:
1. ____________________________________
(location name or address)

1. ______________________________________
(routine sample location name or address)
Description: ____________________________
(hose bib, sink faucet, etc.)

2. ______________________________________
(location name or address up-stream)
Water samples will be collected from this location during
the months of (circle):

3. ______________________________________
(location name or address down-stream)
1st Qtr: Jan. Feb. Mar.
4. ______________________________________ 2nd Qtr: Apr. May Jun.
3rd Qtr: Jul. Aug. Sep. (source)
4th Qtr: Oct. Nov. Dec.

72 North Main - P.O. Box 129
Garland, UT 84312
[phone]

Garland City Water System Site Sampling Plan

Garland City
System# 02009
Population Served, 2400
Required Samples Per Month, 2
Generated 9/29/2017
Plan Maintained by Matthew Cutler
Phone: [phone]
Email: [e-mail]

Sample Map Site Locations

Location 1
Harris Market, 86 South Main.
Sample from sink faucet.
Location chosen because it is connected to the 10 inch main line that connects the north and
south distribution line. Also because of the ease of access during business hours.

Location 2
Pie Dump, 20 West 1400 South
Sample from sink faucet.
Location chosen because it is connected to the main south distribution line from the pump house.
Also because of the ease of access during business hours.

Location 3
Bear River Natatorium, 1500 South Main
Sample from sink faucet.
Location chosen because of the proximity to the main south distribution line from the pump
house. Also chosen because of ease of access during business hours.

Location 4
Garland City Inc, 72 North Main
Sample from sink faucet.
Location chosen because of the proximity to the main north distribution line from the pump
house. Also chosen because of the ease of access during business hours.

Repeat Sample Instructions

Repeat sample at original site where violation happened. Also sample from a connection 5
service lines upstream and downstream from the repeat location site. Please repeat sample same
day as the violation and notify the contact of the site sample plan, located at the top.
A Family Community

72 North Main - P.O. Box 129
Garland, UT 84312
[phone]

A Family Community