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Click ‘Get Form’ to open it in the editor.
Begin by filling in the top section, indicating the total number of containers and types (filters, media, carboys) you are sending. This ensures accurate processing.
Complete all required fields including Collector ID, Sequence Number, Date and Time of collection, Reason Code, Cost Center Code, Program Code, and SAC or Suite. Each field is crucial for tracking your sample.
If using legal seals, write the complete identifier in the designated box. Ensure each seal is listed individually for clarity.
Provide the Public Water Supply Facility Name and PWSID#. This information is essential for lab identification.
Print your name as the sample collector and sign to confirm relinquishment of the sample. Include the date of signature.
At the bottom of the form, enter your contact information and indicate how you transported the sample to ensure proper handling.
Finally, place your submission sheets in a sealed plastic bag within an ice-filled cooler. Secure them inside for safe transport.
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