3900-FM-BSDW0536
Instructions
8/2015
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF SAFE DRINKING WATER
LONG TERM 2 (LT2) E. coli SAMPLING PLAN TEMPLATE
FOR SCHEDULE 4 SYSTEMS
(ROUND 2)
A schedule 4 system is a system that serves less than 10,000 people. If the system is part of a combined distribution
system, the schedule is based on the population of the largest system in the combined distribution system.
A responsible official for the water system should submit the following information for Department review and approval:
An E. coli sampling plan packet consisting of:
1. PA Accredited Lab for E.coli Enumeration Analysis in Drinking Water. Note that the selected lab conducting the
analysis must be accredited for an enumeration method; presence/absence methods are not acceptable for LT2
source water monitoring.
A list of accredited laboratories can be obtained on-line at:
http://www.depreportingservices.state.pa.us/ReportServer/Pages/ReportViewer.aspx?/LABS/LAB_CERTIFICATION
Note: See the instructions on the following page for a preferred search criteria. Be certain to use keywords “E.coli
(Enumeration)” because searching on “Escherichia coli” will yield a different laboratory accreditation list.
2. On official letterhead of the lab you selected – a one-page summary of the dates when samples will be collected
- mm/dd/yy format. (Sample collection frequency must be at least once every 2 weeks for 12 months).
3. Sample schematic indicating chemical feed application points along with an arrow indicating the exact sample
location. An FPPE report schematic with a hand-drawn arrow is acceptable.
4. Completed E. coli Sampling Location Worksheet (provided on the following pages with instructions).
5. Signature of the responsible official for the water system acknowledging that water system staff would notify the
Department immediately upon discovery of any issues related to timely E. coli sample collection or accurate lab
analysis of any sample.
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3900-FM-BSDW0536
Instructions
8/2015
LT2 E. coli SAMPLING LOCATION WORKSHEET FOR SCHEDULE 4 SYSTEMS INSTRUCTIONS:
If your treatment plant uses surface or Groundwater under the Direct Influence of Surface Water (GUDI) sources
and serves fewer than 10,000 customers, you must complete this worksheet. Completed worksheets must be
submitted to your Regional DEP Office’s Safe Drinking Water Program at least 3 months prior to the start of
your system’s required sampling period.
1. Source Name: List all sources that will be monitored for E. coli. LT2 requires monitoring of your sources
as per normal operating procedures. Therefore, if you normally blend 2 or more sources prior to entry into
the treatment plant; you should collect one blended raw water sample, prior to any chemical addition. Next
to each source, indicate if it is “Blended” or “Not Blended”.
Note: Please list the information for each source in a separate column. Each worksheet allows input of
information for 2 sources. If you use more than 2 sources, please complete additional worksheets.
2. Source Identification Number: For each source, list the source identification number. Contact your local
DEP office if you are uncertain of the source identification number for your source(s).
3. Source Water Sampling Location: Please describe, in detail, the specific location where you will be
collecting your LT2 samples. Note: Samples must be collected from the raw water before the point of
chemical addition and before the point of recycle water return. If you blend sources, the sample location
should include the blended sources. Include a plant schematic, with an arrow indicating your proposed LT2
sampling location.
4. Usage: Please describe, in detail, the specific usage practices for each source–i.e., “All year”, or
“Part-Year/Seasonal” - for your source in recent years and describe the anticipated use in future years. For
Part-Year/Seasonal sources, include the months of operation. Your usage should be consistent with DEP
source permits. Please contact your local DEP office if you are uncertain of how your source is permitted.
5. Proportion of Flow: Provide the most accurate information available regarding the percent (%) of average
yearly flow that each source contributes. Be sure to describe how you determined this % and include
supporting documentation. After providing information for all sources, please clearly indicate (at the end of
the worksheet) which source is your primary source. Your primary source is the source that clearly
provides the majority of water on a yearly basis to the filter plant.
6. Presedimentation, Bank Filtration, or Off-Stream Storage (if applicable): If any of these practices are
utilized, please include them in your plant schematic and indicate if your LT2 sample will be collected
before or after these practices.
7. Recycling Practices (if applicable): On the plant schematic, specified in #3, indicate the point of recycle
return (if applicable). If you do not recycle, please state “Do not recycle” on your plant schematic.
Note: It is very important that the sample location is BEFORE the point of recycle. Samples collected after
re-cycling will be invalidated and re-sampling will be required.
8. Chemical Pretreatment: On the plant schematic, as specified in #3 above, also indicate chemical feed
locations.
Note: It is very important that the LT2 sample location is BEFORE the point of any chemical addition.
Samples containing treatment chemicals will be invalidated; re-sampling will be required.
9. Sample Compositing Procedure: If a blended sample location prior to chemical addition is available, one
blended sample should be collected from this location. If such a sample location is not available, plant staff
may choose to sample each blended source separately. In this case, a composite sample representing %
contribution of each source is needed. Describe Compositing in detail.
10. Bin Submission Due Date or Cryptosporidium Sample Plan Submission Due Date: Enter the exact date
(MM/DD/YYYY) of either the system’s Bin submission or the Crypto Sample Plan submission.
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3900-FM-BSDW0536
Instructions
8/2015
Search Criteria Example - In order to find a PA Accredited Lab for E. coli testing, use the selected options below
which are outlined in red.
If the link in item 1 is not working, please follow these instructions to find the list of PA Accredited Labs:
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Enter www.depweb.state.pa.us into your internet browser
From the left hand menu choose DEP Programs A-Z
Select “L” from the alphabetical menu
Select “Laboratory Accreditation Program”
Under “Search Environmental Laboratories” select “Search PA Accredited Environmental Laboratories Link”
Choose “Select All” for the State Criteria
Choose “Drinking Water” for the Matrix Criteria
Choose “E. coli (Enumeration)” for the Analyte Criteria
Choose “Select All” for the Method Criteria
Select “View Report” in upper right side of page
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3900-FM-BSDW0536
Worksheet
8/2015
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF SAFE DRINKING WATER
LONG TERM 2 ENHANCED SURFACE WATER TREATMENT RULE
E. COLI SAMPLING LOCATION WORKSHEET FOR SCHEDULE 4 SYSTEMS
Public Water System (PWS) Name:
PWS ID #:
Water Treatment Plant Name:
Water System Facility ID:
Name and Phone Number of Person Completing this Form:
1. Source Name
2. Source Identification Number
3. Source Water Sampling Location (Raw
water tap or sampled at source, and location
description)
4. Usage (All year, or part year. Provide
conditions, constraints and months in
operation)
5. Proportion of Typical Average Daily Flow
%
%
6. Pretreatment Practices (if applicable)
(Presedimentation, bank filtration, or
off-stream storage)
7. Recycling Practices (if applicable)
(Description and return flow location)
8. Chemical Pretreatment
(Also indicate location on drawing)
9. Sample Compositing Procedure (Blended
sample tap, composite sample or weighted)
10. Bin Submission Due Date
or Cryptosporidium Sample Plan
Submission Due Date (MM/DD/YYYY)
Primary Source
If you have questions, please contact your Regional DEP Office’s Safe Drinking Water Program. For a list of DEP offices see
Appendix I or visit the following page –
http://www.portal.state.pa.us/portal/server.pt/community/about_dep/13464/office_locations/585263
Use additional sheets or reverse side to provide more information
I acknowledge that water system staff would notify the Department within 24 hours upon discovery of any issues
related to timely E. coli sample collection or accurate lab analysis of samples.
“The information contained herein is true and correct to the best of my knowledge, information and belief. The
information given is subject to the penalty provisions of the Crimes Code regarding unsworn falsification to authorities
(49 P.S. §4904).”
Signature
Date
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3900-FM-BSDW0536
Worksheet
8/2015
Appendix I: Department of Environmental Protection (DEP) and
County Health Department (CHD) Offices Contact List (Revised December 2014)
County
PWS ID#
1st 3 Digits
Adams
* Allegheny
701
502
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
** Erie
503
504
405
306
407
208
109
510
411
612
313
414
115
616
617
418
419
620
721
722
123
624
625
Fayette
526
Forest
Franklin
Fulton
Greene
627
728
429
530
Huntingdon
Indiana
Jefferson
Juniata
431
532
633
434
Address
150 Roosevelt Ave., Ste. 200, York, PA 17401
Allegheny Co. Health Dept., PDWWM, Bldg. 5,
3901 Penn Ave., Pittsburgh, PA 15224
131 Broadview Rd, New Stanton, PA 15672
715 15th St., Beaver Falls, PA 15010
3001 Fairway Dr., Altoona, PA 16602-4473
1005 Cross Roads Blvd., Reading, PA 19605
3001 Fairway Dr., Altoona, PA 16602-4473
600 Gateway Dr., Mansfield, PA 16933
2 E. Main St., Norristown, PA 19401
121 N. Mill St., New Castle, PA 16101
286 Industrial Park Rd., Ebensburg, PA 15931-4119
186 Enterprise Dr., Philipsburg, PA 16866
5 W. Laurel Blvd., Pottsville, PA 17901
186 Enterprise Dr., Philipsburg, PA 16866
2 E. Main St., Norristown, PA 19401
1st Floor, White Memorial Bldg., 310 Best Ave., Knox, PA 16232
186 Enterprise Dr., Philipsburg, PA 16866
186 Enterprise Dr., Philipsburg, PA 16866
309 N. 5th St., Ste. D, Sunbury, PA 17801
230 Chestnut St., Meadville, PA 16335
150 Roosevelt Ave., Ste. 200, York, PA 17401
909 Elmerton Ave., Harrisburg, PA 17110
2 E. Main St., Norristown, PA 19401
321 N. State St., North Warren, PA 16365
DEP, 321 North State St., North Warren, PA 16365
Erie Co. Health Dept., 606 W. 2nd St, Erie, PA 16507
25 Technology Dr., California Technology Park,
Coal Center, PA 15423
321 N. State St., North Warren, PA 16365
150 Roosevelt Ave., Ste. 200, York, PA 17401
150 Roosevelt Ave., Ste. 200, York, PA 17401
25 Technology Dr., California Technology Park,
Coal Center, PA 15423
3001 Fairway Dr., Altoona, PA 16602-4473
286 Industrial Park Rd., Ebensburg, PA 15931-4119
1st Floor, White Memorial Bldg., 310 Best Ave, Knox, PA 16232
909 Elmerton Ave., Harrisburg, PA 17110
* = County Health Department
** = Transient Noncommunity Water Systems (TNCWS) are under the County Health Department.
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Telephone
Number
717-771-4481
412-578-8047
724-925-5500
724-847-5270
814-946-7292
610-916-0100
814-946-7292
570-662-0830
484-250-5900
724-656-3160
814-472-1900
814-342-8200
570-621-3118
814-342-8200
484-250-5900
814-797-1191
814-342-8200
814-342-8200
570-988-5500
814-332-6899
717-771-4481
717-705-4708
484-250-5900
814-723-3273
814-723-3273
814-451-6700
724-769-1100
814-723-3273
717-771-4481
717-771-4481
724-769-1100
814-946-7292
814-472-1900
814-797-1191
717-705-4708
3900-FM-BSDW0536
Worksheet
8/2015
Appendix I: Department of Environmental Protection (DEP) and
County Health Department (CDH) Offices Contact List (Revised December 2014), continued
County
PWS ID#
1st 3 Digits
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
235
736
637
738
339
240
441
642
643
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
Out of State
444
245
146
447
348
449
750
151
252
653
354
455
456
257
258
259
460
661
662
563
264
565
266
767
999
Address
321 Spruce St., Ste. 300, Scranton, PA 18503
1661 Old Philadelphia Pike, Lancaster, PA 17602
121 N. Mill St., New Castle, PA 16101
1661 Old Philadelphia Pike, Lancaster, PA 17602
4530 Bath Pike, Bethlehem, PA 18017
2 Public Sq., Wilkes-Barre, PA 18701-1915
208 W. 3rd St., Ste. 101, Williamsport, PA 17701
321 N. State St., North Warren, PA 16365
(South) 121 N. Mill St., New Castle, PA 16101
(North) 230 Chestnut St., Meadville, PA 16335
3001 Fairway Dr., Altoona, PA 16602-4473
2174B Rte. 611, Swiftwater, PA 18370
2 E. Main St., Norristown, PA 19401
309 N. 5th St., Ste. D, Sunbury, PA 17801
4530 Bath Pike, Bethlehem, PA 18017
309 N. 5th St., Ste. D, Sunbury, PA 17801
909 Elmerton Ave., Harrisburg, PA 17110
2 E. Main St., Norristown, PA 19401
2174B Rte. 611, Swiftwater, PA 18370
600 Gateway Dr., Mansfield, PA 16933
5 W. Laurel Blvd., Pottsville, PA 17901
309 N. 5th St., Ste. D, Sunbury, PA 17801
286 Industrial Park Rd., Ebensburg, PA 15931-4119
600 Gateway Dr., Mansfield, PA 16933
321 Spruce St., Ste. 300, Scranton, PA 18503
600 Gateway Dr., Mansfield, PA 16933
309 N. 5th St., Ste. D, Sunbury, PA 17801
230 Chestnut St., Meadville, PA 16335
321 N. State St., North Warren, PA 16365
715 15th St., Beaver Falls, PA 15010
321 Spruce St., Ste. 300, Scranton, PA 18503
131 Broadview Rd, New Stanton, PA 15672
2 Public Sq., Wilkes-Barre, PA 18701-1915
150 Roosevelt Ave., Ste. 200, York, PA 17401
PA DEP, Bureau of Safe Drinking Water, Division of Operations &
Monitoring, P.O. Box 8467, Harrisburg, PA 17105-8467
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Telephone
Number
570-963-4521
717-299-7601
724-656-3160
717-299-7601
610-861-2070
570-826-2511
570-327-3490
814-723-3273
724-656-3160
814-332-6899
814-946-7292
570-895-4040
484-250-5900
570-988-5500
610-861-2070
570-988-5500
717-705-4708
484-250-5900
570-895-4040
570-662-0830
570-621-3118
570-988-5500
814-472-1900
570-662-0830
570-963-4521
570-662-0830
570-988-5500
814-332-6899
814-723-3273
724-847-5270
570-963-4521
724-925-5550
570-826-2511
717-771-4481
717-772-4018
3900-FM-BSDW0536
Worksheet
8/2015
Additional Comments:
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