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HomeMy WebLinkAboutDDW-2025-003197SA M I P L E CO L L E C H O N IN S T R U C T I O N S Pub l i c Wa t e r Sy s t e m It e m s ma r k e d wit h an * mu s t be com p l e t e d for rec o r d to exi s t . Sam p l e s sho u l d be col l e c t e d fr o m con s u m e r ' s col d wa t e r tap s . Av o i d fre e z e - l e s s yar d hyd r a n t s an d tap s wit h aer a t o r s , ser e sc r e e n s or hos e - b i b typ e thr e a d s . San i t i z e fau c e t wit h alc o h o l wip e . Th e fau c e t sho u l d be ope n e d an d all o w e d to ru n for 3 to 4 mi n u t e s bef o r e sam p l i n g . Fil l sam p l e bot t l e ab o v e 10 0 ml lin e . Th e lab o r a t o r y mus t rec e i v e sam p l e s wit h i n 30 hou r s of col l e c t i o n or wit h i n 6 hou r s fo r com p l i a n c e sur f a c e wa t e r sam p l e s . Wri t e sys t e m th e Sys t e m ID nu m b e r on bot t l e in bla c k sha r p i e (to ide n t i f y if sep a r a t e d fr o m slip ) SE N D RE P O R T TO : NA M E : CV S S D AD D R E S S : Po Bо x 87 7 CITY : Cast l e dal e STA T E : U T ZIP: 845 1 3 PH O N E : 435 - 3 8 1 - 5 3 3 3 811 @ e t r . n e t *EM A I L : CV S S D Pri v a t e We l l or Inv e s t i g a t i v e Fil l ou t con t a c t inf o r m a t i o n inc l u d i n g em a i l wh e r e you ' d lik e res u l t s sen t . Sam p l e s sho u l d Ibe col l e c t e d fr o m a col d wa t e r tap . Avo i d fre e z e - l e s s yar d hyd r a n t s an d tap s wit h aer a t o r s , sc r e e n s or hos e - b i b typ e thr e a d s . Th e fau c e t sho u l d be ope n e d an d all o w e d to ru n for 3 to 4 min u t e s bef o r e sam p l i n g . Fill sa m p l e bot t l e ab o v e 10 0 ml lin e Th e lab o r a t o r y mu s t rec e i v e sam p l e s wit h i n 30 hou r s of col l e c t i o n . Wri t e da t e an d tim e col l e c t e d on bot t l e in bla c k sha r p i e (to ide n t i f y if sep a r a t e d fr o m slip ) Mai l sam p l e s wit h lab slip to: So u t h e a s t Ut a h He a l t h De p a r t m e n t Wa t e r La b 14 9 Ea s t 10 0 So u t h Pri c e , UT 84 5 0 1 To upd a t e con t a c t inf o r m a t i o n ple a s e em a i l Jo n a t h a n Du t r o w at jdu t r o w @ u t a h . g o v RE P E A T SA M P L E LAB # : DAT E : ORI G I N A L SIT E SO U R C E UPS T R E A M Alt e r n a t i v e (RTC R ) DO W N S T R E A M Oth e r (TCR ) IMP O R T A N T ! ! LA B # MU S T BE TH E SA M E AS OR I G I N A L RO U T I N E SAM P L E ! ! SOUT H E A S T UTA Н DEPA R T M E N T So u t h e a s t Ut a h He a l t h De p a r t m e n t Wa t e r La b Lab Nu m b e r : UT 0 0 9 3 1 | 14 9 Ea s t 10 0 So u t h Pri c e , UT 84 5 0 1 | (43 5 ) 63 7 - 3 6 7 1 *W A T E R SY S T E M ID : 0 8 0 4 0 SA M P L I N G LO C A T I O N : WA T E R SY S T E M NA M E : Cle v e l o n d E m o 90 Nor t h 30 0 ea s t SA M P L E CO L L E C T E D BY: Ka s h Je w e k s IS SA M P L E CH L O R I N A T E D ? ☑ YE S NO RES I D U A L : 3 PP M *D A T E COL L E C T E D : 2-1 1 - 2 5 *Fa c i l i t y ID: SEE REV E R S E FO R SA M P L I N G INS T U C T I O N S RE S U L T S OF ANA L Y S I S TOT A L COL U F O R M PE R 10 0 ml. TO T A L ml. AB S E N T MP N E. COL I CO per 10 0 mml. _ TO T A L HP С C per 1 ml. Ru n Tim e : IS SA M P L E IC E D ? ☐Y E S NO LA B # Dat e Ana l y z e d : Dat e Repo r t e d : , Ana l y s t : *T I M E CO L L E C T E D (24 hr. CLO C K ) : 10 : 3 5 *S a m p l i n g Poi n t ID: 2-D S 0 0 1 IN T E R P E T A T I O N OF ANA L Y S I S A. SAT I S F A C T O R Y : AS TO BAC T E R I A CO U N T . В. UN S A Б. ON S A SAT I S F A C T O R Y : TO T A L CO L I F O R M POS I T I V E SAT I S F A C T O R Y : TOT A L COL I F O R M POS I T I V E C. UN S A SAT I S F A C T O R Y : TO T A L COL I F O R M AN D E. COL I POS I T I V E SA M P L E NO T AN A L Y Z E D AP S E D F. E X C E S S I V E TIM E ELA I G. S A M P L E LEA K E D G. SAM P L E LEA K E D H. LA B ER R O R LO T H E R 00 : 2 1 - 0 0 2 1 Dri n k i n g Wat e r / P o o l Sa m p l e 21 1 1 2 5 2/1 2 / 2 5 *T H I S SA M P L E IS A: ☑R O ROU T I N E INV E S T I G A T I V E RE P E A T *A N A L Y S I S ME T H O D : PRE S E N C E - A B S E N C E MP N COL I F O R M S / E COL I HP C