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									                                      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): ___________________________________________
                                                             Source 1                                Source 2
1. Source Name


2. 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)




TCEQ-20358 (06/17/08)                                                                                                         Page 1
                                         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): ___________________________________________


                                                             Source 1                                Source 2
1. Source Name


2. 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)




TCEQ-20358 (06/17/08)                                                                                                         Page 2
                                         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): ___________________________________________


                                                             Source 1                                Source 2
1. Source Name


2. 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

								
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