DDW-2024-006647

UTAH DEPAnI"ENI oF
ENViRONMENTAL、QUAllTY
DRINK:NG
WATER
PC)Box 144830
San Lake City,UT 84114‐4830
Phone:(801)536‐4100
Fax(801)53日 211
EmdL ddwrepoお @utah・ 90V
www.d百 nkingwater.utah.9ov
BACTERIOLoGICAL SAIIPLE SITE P|SN
As pafi of the Revised Total coliform Rule, he location frorn uilridr samples are taken is to be vaded, All water systems are
reqi,ir* to maintain a *nenio.aeriologfu sample siling plan. The plan_shovs he bcations of all sample sites from which
baderiologkxl tests are taken. sampb-sites are to oe Lbresentative gI all pressure zones and each water source of the
o[Guutioi iister. nre sampu prrn ir,orro be revised reluhrly and following any major construdion proiec{ impacting the
distribution system.
WATER SYSIM iNFORMA■ON
Systemtlame: AJo€* La6*,rJ C-m{Sysね m tt UTAHlalBI∥[ll151
Phone#:“ζ
'…
b~2-1310StreetAddress,Lo?t* A- lzu €
MJ∥ng AddЮ ss:
SAMPLE COLLEC■ON
Samメ eS ttected諄 名ひ「7、
“
ttotヽ ネしくaF・ い。
Name d bbttbり `Zι「
・ムtrま ぜct lト バ2と ぃ
Mai∥ng Addぃ ま |
State Lb Cdc革 廻 ∝江 二 PhOne由 旦 曇 LIユ 圭 ジ ■FⅨ疵
The Laboratory was sent a copy of sris plan on: k {V | *
Utah DMsion of Waterwas sent a copy of this
Seasonal
is the water operated seasona∥y? l「]YES Ⅲ0Dates of operation: Open:
Systems,which operate seasondり ,are reqttred to take an hvettbaliVe samJe priOr to openhg to the puЫ た。Ⅷhere
wi∥that sample be taken?
Location Date sampled:
MAP OF SYSTEM
Have you enclosed\attached a map of he distribution system showing the source (well, spilng, etc.), storage tanks,
keatment facilities, disbibution piping, routine
SAMPLE LOCAT10NS
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 Samp!e Locatio嘔 FdOル up(repeatl SamJe Loca額 ons
Description:(, * L- (nue.+
(hOSe bb,gnk faucet etc)
Water samples w∥be∞∥ected from this localion du∥ng
lhe months of(drcle)
1.
仲面m mmpb欧 洒いuno or"dresl
心収 年の゛ιtiし いと
(locatbn name oraddress uPstream)
\rLtl o,tuw\aLL
(location name or address do*rr'sfeam)
i+. }A.-XeC\
(source)
2.
1ヨ Qt「
2nd Qtr:
3rd Qt「
4h Qtr:
Jan.
:ノ イヘpr
」ul.
ノOd
/'r"0.
May
I P"s., ,Nov.
Mar.
/.tun.
Sep.
fw"
Follorruo (reoeatl Sam0le Locations:
?,ch;ct r. frcx-?a@*r,{-*}-
(rurtine sample locatidr name or adlress)
哺bハ ーσ」altへ じL
(location narc or addrcss utrstream)
kk vr 6a.le,.laHe
Routine SampL Locatbn:
多cし ヽ
(locadon name or
Description:1**k- &ccl,f
(hOSe bb,曲 kね uCet elc.)
Water samples w∥l be co∥ded frOm this i∝泊lon dunng
the months of(ci由 〉
lSt Qtr:
2nd Qtr:
3rd Qtr
4h Qtri
ヽan
Apr.
＼」ul・
: ,OCt
Feし ｀a■
導¶
Fdbw・ u●(repeat)Samde Locatton=
a. {rce! n Ua".\c.\d-u
(localim nanr or ddmss dow+etem)
μ、J1●Qtr:
2面 Ql「
3d Qtr
401 Qtr:
Routine SamDle Locat:on:
11qZ じ,Description:
00Seblb,Snkね uは etc)
Water samples wi∥be collmed輛 Юm this localion duing
the months of(cirClel:
職 ■キ
」an.
/Apr.
」ul.
/Oct.
(SOurCe)
Rercrt PrePared lY' /ft4'tlder\,r*-l
Signature and l日 」el ″″イだ
`ヒ `22``″=?⊆ゎしt・ l Daほ 丘並・■
name o「address)
レk
SAMPLE LOCAT10NS
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.
DesCri師 帆 うい平ぐ畝、ca_ゝ
(hOSe昴 ,gnk枷 はelc)
Water samples wi∥be∞∥ected from this location dunng
the months of(drcle):
Followuo {rcpcat} Samplc Locations:
, ,tJ ..{.= ! a{ ..;\ a,t'l,r-
- (rurline sample localim nane or address)
z AJ aqL ava,\a^br\L
(location name or addrcss up-sfream)
餞ιンヒ′G′itaし ｀L __
$ocation name or address down*fream)
い面ne Samメ e10mlion nameoraddressl
算、「ぅ午Description: \u\9rcLL5;t^. Y PcL*i cl-\-
(hoss bib, Eink faucat, eh')
Water samples will be collected from this tocation during
the months of (circle):
(location name or address upsteam)
.月 θへ沢hL「
Des面 山正 ろtWし C♂“Y(hOSe tお ,gnkttuet eし)Water samples wi∥be coleded from this:ocalion dunng
the monhs of(dに b)
Follo*up (rcpeatl Sample LocationE:
,. I\\r*\ a n',t,\oL\<
(roiline sample tocatibn name or address)
z. l[..tef, at'r'; \aloLc
(localim name or addess up+froam)
lSI Qtri Jan.
211d Qlr: /Apr.
3僣 Qtr: JUI.
4h Qlri /10ct.
Rouune samp:e Location:
1ま Qtr
2nd Qtr:
3d Qtr
4」l Ql「
/ trn.
Aor.
n;, Oc{.
/u*.
Jun.
,/ sep.
,Dec.
Fd:o静 up irepeat〕Samde Locatton=
(..t /tgdr.'(a"b\-
(location narc u address doym-sbean)
イ磯 ,盟
イ峨: :認:Rou∥ne Samde Loca∥o席
1餞 Qtr:
2nd Qtr
3rd Qtri
401 Qt「:h
SAMPLE LOCAT:ONS
The following describes each routine sample location, what months the location will be sampld, and where follow-up
(repeat) samples will be taken in the event of a "positive' routine sample.
Routine Sample Location:Fdbw‐up(reDeat〕Samtte Loca∥on緊
2.ルLト キ`CaJtぬ らtん
(hOSe bb,Sinklaucet etc.)
Water samples wi∥be co∥ectedお m this localion dunng
the months of(cirCle)
(locatim name or address upstream)
lS Qtr
2nd(】E3d Qtri
40(〕『:ヽ」an.
・ Apr
ヽ」ul.
1 0ct
)駐 《:}
'ヽ
dNOV・ :Dec.
sample location name or address)
namo or
r\ab\-L
dovrn-sbeam)
Rou∥ne Samp:e Location:
1.lη q 2び 、ルマ′θJ
(location name or addrcss)
Description;
Water samples wi∥be co∥ected from this locaton du∥ng
the months of(cirClel:
Fo∥ow・ up“epeat)Sample Locattons:
1. !ex! qqe'\1U&
(muihe sample locatim nane oad&ose)
Ner.)- &t)*.lcr.f,1a-
$ocatirn nann o addess upsbeam)
Nilu"tr &,,)ct" t,.U[+-
(localion name or address dowNfream)
a. y';\l-ac\.
(source)
2.
1'Qtr
2nd Qt「
3rdミ 、
4h Qtr:
Jan.
:ノ Apr.
」ul.
act,
/ reo.
May
/Aug.
r Nov.
Mar.
/Jun
Sep.
/beC
ぃい平鐘♂θ=(hOSe bib,Shklbttt etc)
Fo∥o‐up rrepeatl sampie LocalionsI
l. 鱗 年aO“:ヽ んしuし
(mutiB sample localim nane aaddress)
2. fJ o,.u\ A.$&"\,iiVl&
e x\w\ a,trx;\e,!i^e,
(localirn name a address dom-strtdn)
Routhe Samob Location:
1.l侵 り行 こ_ 矢らわDS・
(10CabOn namecaddressl
Description:C..,,.-t- f*-eo+
(hose bb, siok faucet dc.)
Waier samples will be collected from lhis location during
the months of (circle):
1試 Qt「
2nd Qtri
3d Qtr:
4h Qtr:
/Jan Feb.
: Apr. 〆May
鋼 .ス1 武 cン 」
lSOurCe)
SAMPLE LOCAT10NS
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.
うζにいに
lhOSe bb,Shkね ucet etc)
Water samples w∥be collected from this 10calion dunng
the months of(drcle)
Routine Samole Location :
tQ r<*:'\:'\\.P O\ e'*" ..}-'l
' (localton name or addcss)
(location narne or address up-slream)
\J'g,o! a,lrrt hU{-
Routine Samole Locatbn:
r lt c',*,L{s:. !- ...F\q*L^Vol
(looalim name o addrcss)
3,*L Q.rcr-L
(hOSe ubi shk faucet,etc.)
Water samples wi∥be co∥ected iom this iocalon dunng
0,4r.\ a,uct;\abLe
(routine mmple location name or address)
J["*I alc,;teblL
(location name u address uPsfeam)
,[)q.r.I- adct;tobLche months of(drcle〉
lS Qtr Jan.
雷計 /::[
Routine Samole Location:
1. L-n rp.,wt Lara.,.. C;H S.ax,i-,-' (location Mne or a<drcss) I
Description: ,vt< . ciA S :un f- e,"'.lcc'l-
(rOume samplelomlon n帥 o oradd日 、)蠅ρヵ■^」
どい｀k(localim narr or addrcss upstam)
3 k\r-*L ar&t-\obLe
@
ら町 1.
(hose bb, eink hucat eb.)
Water samples will be collected from this location during
the months of (cirde):
Fo∥ow‐up freDeatl Sample Locations:
Description:
/tutur.
Jun.
/sep.
, Dec.
(location nane or address dourn-steam)
1●Qt「
2nd Qtri
3に Qtri
4h Qtri
/,tan.I Apr.
/lul.
Oct.
Description:
(locatbn mrm or addtBss dor*sfuoam)
fln r >"ad
Fdbw・ up lrepeat〕SamJe Loca∥on=
1゛ Qtr
2nd Qt「
3に Qtr
4訥 Qtr:
/澪|/JJ・
: 10ct.
Feb.
/May
Aug.
/Nov.
/Man
/sep.
Dec.
SAMPLE LOCAT10NS
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.
Routne Samole Locatlon:
,hw"Cwr4o* {;a* ULr*i
(localion name u addrcs)
00Se bb,jnkね ucet配)Water samples wi∥be comected from this 10caton dunng
the months of(cirCle):
餃tXぞAt,曇―αよ武ユしに
(location name u address upsteam)
[ocation name or addrcss down-steam)
Water samples will be collected from this location during
the months of (circle):
盤 /辮41‐燃i(hOSe bb,SnklauoOt elc.)
でic去 畑a)し しじ
(localion name or address dovn-steam)
(SOurCe)
Routine Samole Location:
- -/-
1. fuvtrfucu**9
(locatilm name or address)
1.___三
二 重 ■土
=婆
=全
二 L型 峯 望 隼 =___
Desc∥師0正 ¨鰺られい
(location name or address up-sbeam)
Water samples wi∥be collected from this localon dunng
the months of(cirCle〉
(location name or address dom-sfmm)
(hOSe bb,gnk fau∞t etc)
Report Prepared by:
Signature and Titld Daじ 立
Fdbwoup lrepeat)SamJe Locattons
Description:
1獣 QL ヽR
2nd Qに :Apr.
3rd Qtr ｀ヽ」ul.
401 Qt「: :Oct.
Feb.
￢ay
Aug.
Nov.ヽ p・
Dec
,-V Vaotx.
ヽ
Roulne Sample Loca∥on:Fdbw・ up lrepeaO Sampに Locattons:
Description:
1餃 Qtr:
2nd Qtr
3“Qtr
4h Qtri
Fdbw・ up freDeat)Samde Loca∥on収
Feb_ ′Mar.
′May .Jun.AuO /Sep
′Nov. :Dec.
SAMPLE LOCAT:ONS
The following describes each routine sample location, what months the location will be sampled, and where follow-up
(repeat) samples will be hken in the event of a "positive" routine sample.
・摯鳴縣癬qttQ蛉 ‐雌ヘ
addFeSS)
もじ斗aも 藁
S,oL- Q.u.-+
(mutine sample location name u address)
f.rgl'tw Lu-q-
00seub,snk伽 は山〕
Water samples wi∥be∞∥ecled ttЮ m llls localion dunng
the monhs of(drde)
(location nane u address upsteam)
(rouline sample locatio name or address)
?***o, 9r'n F
00Se Ыb,Snkね u軌 に)Water samples win be cOllected from this:oCaton du∥ng
the months of(drcle):
(locatkm name or addross utrstoam)
I){."^l a.q at\at'k_
●OSe bbi gnk hu醜 etC→
Waler samples w∥be co∥ected from this localion du∥ng
the months of(drcle)
(localbfl nare or addrcss dovrn-sfre8m)
IJan。 ノFeb.
1/い r. : May
l Jd・ /攣 ・
4. A/,. XCC\
(routine samplo location name or address)||Folbttup〔repean Sample Loca∥ons
驚 `墨
1紋 Qtr:
2nd Qtr:
3●Qtr
4ul Qtr
(hcation nare or address dorn-sbeam)
Rou∥ne Sample Loca∥on:Fdbw・ uD(reDeat〕Sampに Loca∥Ons
3. 11
(10CatOn name or address down‐strem)
Feb. /Mar.
郵4
Rouune sample Location:
Description:1, nY l-artc<-l
lSI Qtr:
2nd Qtr:
3“Qtri
4h Qtri
Fdbw・ up frepeat〕Samde Localon=
kゝ Qン ト久vば しЪL