DDW-2024-006782

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DRINKING
WAT麿 彙
PC)Box 144830
Salt Lake City,UT 84114‐4830‐
Phone:(801)536‐4100
Fax[phone]
EmdL ddwrepons@utah.90v
―.drinkingwater.utah.9ov
BACTER:OLOGiCAL SAMPLE SiTE PLAN
As part ofthe Revised Tota:Colilom Rule,the localoo From Whkね samples are taken is to be valied. A∥water systems are
required to maintain a current bacteriob9ical sample siting plan.The plan shows lhe localions of a∥sample sites from whch
bacte"obJcJ tests are taken.Sam口 e Stes are to be representatve of al presSore zones and each water source of the
distribulon Sy,lem.The sam口 e口 an shOuほ be reused re9酬 aay and fO∥owi,9 any maor constnJction proiect impacting the
distributon system.
MAP OFISYSTEM
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 Yesi鮮 INo
WATER INFORMバ
System Name:
Street Address:
System#:UTAHIslblHIl翻 Il
Phone着 奪 弄 乃管 ―名 ″
MtthO A“鰯 Em識 ノ
Service Conneclions:$erved:
SAMPLE COLLECT10N‐ i
Name of Laboratoγ:Ma∥ng Address:“陛r遭 箸ノ働夕´Jノ Zシ 蒻. 勝 ′グタタノ
statelab cAde: /g/?y{ Phone#: 4€€* 79 3 -afrz Fax#:
The Laboratov was sent a∞py ofthも 口an o鷹 ∫ア″―/,
Utah Division of Drinking Water was sent acopyof this plan on: 5' ?l -t g-
‐seasonal
ls the wateroperated seasonally?国 YES 輌NO
Dates of operaliott Oper"ん И / Closα ル
`〆
Systems, wlrich oper:ate seasonally, are rEuired to take an investigative sample prior to opening to the public. Where
will that sample be taken?
Date sampled, N *
饉
量|露
議
議
菫
奪
躍
Cache Valley Public Shooting Range
Site Sampling Plan
sample tap #Location DESCRIPT ON1
Main Bu∥ding Mens restroom sink2
Main Bu∥ding womens restloom sink3
Main Bu∥ding Breakroom4
Main Building lanitorial closet5
Frost Free TaD Behind old pump house6
Shotgun Bldg Restroom sink7
Frost free tap Shotgun Field d"ider wali far west8
Frost free tap Shotgun Field divider far center west wall9
Frost free tap Shotgun Field d vider East wai:
10 Pump house lnside pump house
SAMPLELOCAT10NS■: . :
The following describes each routine sample location, what months lhe location will be sampled, and where follow-up
(repeat) samples will be taken in the event of a'positive'routine sample.
00CabnamOoraddressl
θ′″た
O10Se m、dnkね uc軋 勧R)
Water saln口 eS輛 ∥be∞lbcted frOm thに bcalion dunng
he monhsof{dヽ、
11CL ttJah。 □Feb, ||□睦■
2nd砒 □ApL □May □Jun.
"転
= □lJ.・ □Augil‐ □ⅢIFollovu-uo (rsoea0 Sample Locafons:
1. l,t%,+*. .2.e;e!*oo n a p k? Aan FUil
(outne samS localim nztr oraddress)
2. J*p,b,n0 (t ."* ,nz
@lin name or addess up-stedr)
l. fi*l rze' ft'lt (f& qr An ,*)
■屹M御 ,&ダ K・・ ′ヘ
(location name o addrcss)
9tatt<
(hce bfu, dnk hucel Eb.)
Wata samples trill be colleded from this location during
the months ol (circle):
目 譜
1‐
唱 肝:口
“
:‐11□鞠:図Nov。 □臨
FdittuD ttDem Samde Locauons:
1.塾 生 墾 準 ニ ニ 窪 憂 黎 率 撃
笙 嚢 勲 堕
響
L撃 些
均
ご と
2.
(hosam,JnIErcsi eb,)
Wabr samples uill be otbded ftom this localion duiry
:‐.11町 ■.□■1・
2nd眈 □ApL
3"∝||□IJ.■‐
1臨 価 nalne∝
Report Preparcd by:
Signaturc and TiUe:
SAMPLE LOCAT10NSI I ■ ‐ ■
The following descdbes each routine samph location, wtrat months the location will be sampled, and where follow.up
(repeat) sampbs will be taken in the event of a'positive" mutine sample.
t島
“
餞 5解 亀 ハ ル・ .め
(ro{ine sanph bcalion name oraddross)
2れ ′ん′ノι冴/″め
0"Ob肛 蒟kね u"t etc)
Water sampies wi∥be∞:lected mm this 10caton du∥ng
he monhsoflCide)
11CL I □Jail
劉吐 図ApL
I卸 眈|■ □JJ:|
4h眈 □Oct.
□Feb二 : □M証:□May □Jun.
口Auo■ 三日詢|.111‐
□No■ □Dec.
Follow-uo (Eoeatl Samote Locations:
l.'filona " t/ooru Aarn btlt)
(rurtrto sen$ bcdho name carllnss) u
3,∠曇蟹撃■具墨学生≦象1像 ヒ44堕 」」墨ら
0etib,dnf hrceteb.)
samples witlbe ok&d from his bcation dudng
l montlsoflCtrde)
11町 :■・ □Jani
2nd眈 □Ap■
鋼町11 ‐□」vL I
2.ミa″′″
(loca6on name or addrcss up+beam)
1.ル “止もοぁ /だ :ん Йι′
(hcebD,sinkhucet, da)
Water samples will be collected from this localion dudng
the months of (cide):
目雛‐目器‐ 目蠍・□Od. □Nov。 □Dec。
er kovu (*,
(localioo name or address ulsEeam)
The following describes each routine sample location, what months the location will be sampled, and where follow-up
(repea0 samples wtll be taken in the event of a 'positive' routine sample.
00SebL ttkね じは血)Water samp!es哺 ∥be∞∥eded mm this:Ocalion duing
the monhsoflcirdel:
|■1代 濃 :■□JO「|2Qに □
“
『."吐 国JuL
40眈 □餞
(bcalior name o address upsEear)
3//as′九 ι
Followuo (rcoed) Samole Locadons:
t. r\te,Z le.L l^^*. (razuA*\
(rurline sans lootior mme or address) / '
0r@ Ub. rfid(tucot eb.)
Wder samples will be olleded tom this locaton dudng
the monhsof (cirde):
ldQ{n [.lan.2,dom [npr.SdQtr: [1.tu1.,
(hce bb, sink hucel etc)
Water samples will be collected from his location during
the months of (cirde):
=11,`h l l□Jai:■
2nd眈 □ApL
I“転| |□:Jur11‐
401眈 □OCL
4 ⊆)