Rtcr General Sample Siting Plan Template - Ohio Environmental Protection Agency
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8General Total Coliform Sample Siting Plan Template
Division of Drinking and Ground Waters
(Revised 1/31/2018)
This template is intended for all public water systems except seasonal systems. If you operate a seasonal public water system, you
must use the “Seasonal Total Coliform Sample Siting Plan Template.” Contact the local Ohio EPA District Office for assistance.
Water System Information
Water System Name:
PWS ID Number: OH
Water System Address:
Water System Contacts
Primary Contact
Name:
Cell Phone:
Email:
Home Phone:
Addre
Backup Contact
ss:
Name:
Cell Phone:
Email:
Home Phone:
Addre
Laboratory Contacts
ss:
Primary Laboratory
Name:
Phone Number:
Address:
Certified Lab #:
Days of week/times lab will accept samples:
Backup Laboratory
Name:
Phone Number:
Address:
Certified Lab #:
Days of week/times lab will accept samples:
Section 1. Total Coliform Sample Locations
Section 1. Routine Location:
(Location where a monthly/quarterly sample is collected (e.g., women’s restroom))
If the Routine is unsafe (positive/present), collect the samples in Sections 1a and 1b (if applicable) within 24 hours:
Section 1a. Repeat Locations
What should I do if I only have 1 acceptable
sample tap?
Repeat #1:
(Same sample location as the Routine location)
Collect all 3 repeat samples from the same
sample tap and let the water run 5 minutes
Repeat #2:
between collecting each sample.
(Sample location within 5 taps closer to the well/source)
Repeat #3:
The Routine and all 3 repeat sample locations
should be the same (e.g., women’s restroom).
(Sample location within 5 taps further from the well/source)
Source
Routine
Treatment
(well)
Raw
Repeat #2
Repeat #1
Repeat #3
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