Latest round of residential sampling form for comments, etc.
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DRINKING WATER LEAD AND COPPER SAMPLING INSTRUCTIONS, | Formatted: Font: Bold
~_- [ Formatted: Centered
Dear Resident: '[ Formatted: Font: 12 pt, Bold
Thank you for helping to monitor for lead and copper in your drinking water. This sampling effort is
required by the U.S. Environmental Protection Agency and the Michigan Department of
Environmental Quality, and is being accomplished through the cooperation of homeowners and
residents.
It is important that you follow these instructions so that we may collect an accurate measurement of
the lead and copper in your drinking water. This sample is supposed to represent the water you
would typically drink and the faucet from where you would drink the water. Call your water supply if
you have any questions.
1.4 sample is to be collected after water has been sitting in the pipes for an extended period of time
(i.e., nO water use during this period). A minimum 6-hour period suring which there Is no water
use from that tap must be achieved prior to sampling. Wé J iH
faucet has sat idle for more than 12 hours. If the faucet | = a idie more than 18 hours, the
sample may not be analyzed,
Due to this requirement, either early mornings or evenings upon returning from work are the best <- ~~ [ Formatted: Indent: Left: 0.25"
times for collecting samples. The collection procedure is described in more detail below.
2. Select a faucet in the KITCHEN or BATHROOM that is commonly used for drinking. DONOT ___.___Fermatted: Font fod
sample from a laundry sink or a hose spigot as these samples cannot be used by your utilitywater sd Formatted: Font: Bold
supply. °{ Formatted: Font: Bold
3. ee en eng ernie a
iH cL-has-satidle Fe-the: Hof
: Bold
4. If you have a single handle faucet, turn it to the COLD side. Place the sample bottle (open) below _ (Formatted: Font:
the faucet and gently open the cold water tap. Fill the sample bottle to the neck of the bottle with
the “first draw’ of COLD water. - -| Formatted: Font: Bold
5. Tightly cap the sample bottle and place in the sample kit provided. Please review the sample kit
label at this time to ensure that all information contained on the label is correct.
6. Answer the questions on the back of this form and remember to sign the form.
7. Attach this form to the bottle and leave it outside your front door for pick-up.
| 8. Thanks you again for your help. We will send you the results within 30 days of receiving them.
Information on this year’s lead and copper monitoring will be printed in the Consumer Confidence
| Report that will be made available to you by July 1 of next year. Contact your utiltywater supply if
you have any questions.
+
If you have any questions call: “--{ Formatted: Number of columns: 2
Water Supply: Manager or
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Water Operator:
DEQ Contact:
Phone:
Phone:
Or Contact:
Michigan Department of Environmental Quality
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A.
( Kitchen {i Main bathroom _{] Other
if OTHER, please describe:
B. When was the faucet last used before sampling?
Date TIME AM/PM
Cc. When did you fill the bottle?
DATE TIME AM/PM
D. is this faucet connected to a home treatment device such as a water softener, a
reverse osmosis unit, an iron removal device OR is any kind of additive used in the
home? YES NO
If YES, please describe:
E. If any plumbing repairs or replacement has been done in the home since the previous
sampling event, please note this information here:
If YES, please describe:
| have read the Drinking Water Lead and Copper Sampling Instructions and have taken a tap
sample in accordance with these directions.
Signature
Date
pas
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