Texas Commission on Environmental Quality
Raw Surface Water Sampling Report
E.Coli Only
Long Term 2 Enhanced Surface Water Treatment Rule
PWS Name: ______PWS ID: ______
Water Treatment Plant Name: ______Water Treatment Plant ID: ______
Contact Name (Please Print): ______
Contact Phone Number (Including Area Code): ______
1. Source Name / Source 1 / Source 22. Source Type
Flowing Stream *
Lake/Reservoir **
GUI - Ground Water Under the Influence of Surface Water
3. Source Water Sample Location ID
4. Usage
Operational – almost all the time
Demand – a few times a year
Emergency – less then one time year
5. Proportion of typical daily flow
(If only 1 source, 100%) / ______% / ______%
6. Sample Collection Date
7. Analytical method number
8. Method type
9. E. coli /100 mL
* Flowing stream is a course of running water flowing in a definite channel. (40 CRF 141.2 Definitions)
** Lake/reservoir refers to a natural or man made basin or hollow on the Earth’s surface in which water collects or is stored that may or may not have a current or single direction of flow. (40 CRF 141.2 Definitions)
Raw Surface Water Sampling Report
Cryptosporidium Monitoring Only
Long Term 2 Enhanced Surface Water Treatment Rule
PWS Name: ______PWS ID: ______
Water Treatment Plant Name: ______Water Treatment Plant ID: ______
Contact Name (Please Print): ______
Contact Phone Number (Including Area Code): ______
1. Source Name / Source 1 / Source 22. Source Type
Flowing Stream *
Lake/Reservoir **
GUI - Ground Water Under the Influence of Surface Water
3. Source Water Sample Location ID
4. Usage
Operational – almost all the time
Demand – a few times a year
Emergency – less then one time year
5. Proportion of typical daily flow
(If only 1 source, 100%) / ______% / ______%
6. Sample Collection Date
7. Type of Sample
Field
Matrix Spike
8. Sample volume filtered (L), to nearest 1/4 L.
9. Was 100% of filtered volume examined?
10. Number of oocysts counted
* Flowing stream is a course of running water flowing in a definite channel. (40 CRF 141.2 Definitions)
** Lake/reservoir refers to a natural or man made basin or hollow on the Earth’s surface in which water collects or is stored that may or may not have a current or single direction of flow. (40 CRF 141.2 Definitions)
Raw Surface Water Sampling Report
E.Coli with Cryptosporidium Monitoring
Long Term 2 Enhanced Surface Water Treatment Rule
PWS Name: ______PWS ID: ______
Water Treatment Plant Name: ______Water Treatment Plant ID: ______
Contact Name (Please Print): ______
Contact Phone Number (Including Area Code): ______
1. Source Name / Source 1 / Source 22. Source Type
Flowing Stream *
Lake/Reservoir **
GUI - Ground Water Under the Influence of Surface Water
3. Source Water Sample Location ID
4. Usage
Operational – almost all the time
Demand – a few times a year
Emergency – less then one time year
5. Proportion of typical daily flow
(If only 1 source, 100%) / ______% / ______%
6. Sample Collection Date
7. Analytical method number
8. Method type
9. E. coli /100 mL
10. Turbidity (NTU)
* Flowing stream is a course of running water flowing in a definite channel. (40 CRF 141.2 Definitions)
** Lake/reservoir refers to a natural or man made basin or hollow on the Earth’s surface in which water collects or is stored that may or may not have a current or single direction of flow. (40 CRF 141.2 Definitions)
TCEQ-20358 (06/17/08) Page 3