GW sample and replicate report form –

Total coliforms & E. coli

 

To be filled out at time of collection:                         

 

Station Name:   ____________________________    Site Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

 

Date:   2 0 0 __ __ __ __ __    Time:  __ __ __ __      District User Code (2 letter code):  __ __

           Y Y Y Y  M M  D D                    (military)

Contact: _________________________________    Phone: (__ __ __) __ __ __ - __ __ __ __

To be filled out by laboratory analyst:                                

Analyzed by (initials):  _________________                Time in 35°C:  ________ (22-24 hours)

Medium lot or batch ID: ____________                       Time out:  ____________                   

Membrane pore size:  0.45 mm                                     Total coliform positive: all colonies which fluoresce

Filter lot number:           __________________                        under UV light – including E. coli

Read by: ____________                                              E. coli positive: blue colonies                           

Colony counts:

 

 

Sample size

(volume - mL)

 Total Coliforms
E. coli

 

Sample

Filter Blank (before plating using sterile buffered solution)

 

 

100 mL –Sample

 

 

Replicate

 

Procedure Blank (before plating replicate using sterile buffered solution)

 

 

100 mL – Replicate Sample

 

 

 

 

Total coliform:

90900

E. coli:

90901

          NWIS parameter codes:

 

RESULTS:

Sample:   ________Total coliforms col./100mL  _______ E. coli col./100 mL

Replicate:   ________Total coliforms col./100mL  ______E. coli col./100 mL