DA Form 7577 Treated Water Sampling Field Data Sheet

DA Form 7577 - also known as the "Treated Water Sampling Field Data Sheet" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 7577 - was last revised on November 1, 2005. Download an up-to-date fillable PDF version of the DA 7577 below or request a copy through the chain of command.

ADVERTISEMENT
TREATED WATER SAMPLING FIELD DATA SHEET
For use of this form, see TB MED 577; the proponent agency is OTSG.
10. COLLECTOR'S PHONE NUMBER
1. SAMPLE ID
11. COLLECTOR'S EMAIL
2. COUNTRY
12. PERCENT OF PERSONNEL EXPOSED (Select one)
3. LOCATION
0
< 10%
10 < 25%
25 < 50%
50 < 75%
> 75%
4. SITE
13. EXPOSURE DURATION (Select one)
5. OPERATION
< 1 week
< 2 weeks
< 1 year
> 1 year
6. SAMPLE DATE (YYYYMMDD)
14. EXPOSURE NOTES
7. SAMPLE TIME
8. COLLECTING UNIT
9. COLLECTOR'S NAME
15. WATER TYPE (Select One)
16. COLLECTION POINT (Select all that apply)
T - Tap/Faucet
DISINFECTED
ROWPU
MUNICIPAL
BOTTLED
B - water buffalo
WT - water tanker
WB - water blivet
FRESH
DS - distribution system
TF - treatment facility
ROWPU
If water type is ROWPU, Municipal
If water type is bottled complete
or Disinfected Fresh complete
these fields below
17. WATER USE (Select one)
(If b, answer 18. If c, answer 18. and 19.)
applicable fields below
MANUFACTURER
15a. OPERATING UNIT
a.
Primary
b.
Secondary
c. Non-Drinking
Drinking
Drinking
BOTTLING LOCATION
18. IDENTIFY THE PRIMARY DRINKING WATER SOURCE
15b. SOURCE OF WATER
19. NON-DRINKING USES: (Select all that apply)
15c. PRIMARY TREATMENT
BRAND
Personal Hygiene
Showering
Cooking
Recreation
15d. ROWPU ID
LOT #
Other
20. ESTIMATED DRINKING RATE (liters per day) (Select one)
less than or equal to 5 liters per day
greater than 5 liters per day
estimated rate in liters per day
o C
21. pH
22. TURBIDITY
NTU
23. TEMPERATURE
24. TDS
mg/L
25. TOTAL COLIFORM
26. FAC
ppm
27. GEOLOCATION
Note: Classified locations should not be entered. They should be sent to oehs@usachppm.army.smil.mil along with Sample ID.
27a. LATITUDE
27b. LONGITUDE
27c. DATUM
27d. MGRS
28. SAMPLING SITE GRAPHIC
18S
UU
83626
01432 Example
29. NOTES (Field Measurements/Observations/Water Quality
Description/# and names of Bottled Water Brands)
APD LC v1.00
DA FORM 7577, NOV 2005
TREATED WATER SAMPLING FIELD DATA SHEET
For use of this form, see TB MED 577; the proponent agency is OTSG.
10. COLLECTOR'S PHONE NUMBER
1. SAMPLE ID
11. COLLECTOR'S EMAIL
2. COUNTRY
12. PERCENT OF PERSONNEL EXPOSED (Select one)
3. LOCATION
0
< 10%
10 < 25%
25 < 50%
50 < 75%
> 75%
4. SITE
13. EXPOSURE DURATION (Select one)
5. OPERATION
< 1 week
< 2 weeks
< 1 year
> 1 year
6. SAMPLE DATE (YYYYMMDD)
14. EXPOSURE NOTES
7. SAMPLE TIME
8. COLLECTING UNIT
9. COLLECTOR'S NAME
15. WATER TYPE (Select One)
16. COLLECTION POINT (Select all that apply)
T - Tap/Faucet
DISINFECTED
ROWPU
MUNICIPAL
BOTTLED
B - water buffalo
WT - water tanker
WB - water blivet
FRESH
DS - distribution system
TF - treatment facility
ROWPU
If water type is ROWPU, Municipal
If water type is bottled complete
or Disinfected Fresh complete
these fields below
17. WATER USE (Select one)
(If b, answer 18. If c, answer 18. and 19.)
applicable fields below
MANUFACTURER
15a. OPERATING UNIT
a.
Primary
b.
Secondary
c. Non-Drinking
Drinking
Drinking
BOTTLING LOCATION
18. IDENTIFY THE PRIMARY DRINKING WATER SOURCE
15b. SOURCE OF WATER
19. NON-DRINKING USES: (Select all that apply)
15c. PRIMARY TREATMENT
BRAND
Personal Hygiene
Showering
Cooking
Recreation
15d. ROWPU ID
LOT #
Other
20. ESTIMATED DRINKING RATE (liters per day) (Select one)
less than or equal to 5 liters per day
greater than 5 liters per day
estimated rate in liters per day
o C
21. pH
22. TURBIDITY
NTU
23. TEMPERATURE
24. TDS
mg/L
25. TOTAL COLIFORM
26. FAC
ppm
27. GEOLOCATION
Note: Classified locations should not be entered. They should be sent to oehs@usachppm.army.smil.mil along with Sample ID.
27a. LATITUDE
27b. LONGITUDE
27c. DATUM
27d. MGRS
28. SAMPLING SITE GRAPHIC
18S
UU
83626
01432 Example
29. NOTES (Field Measurements/Observations/Water Quality
Description/# and names of Bottled Water Brands)
APD LC v1.00
DA FORM 7577, NOV 2005
TREATED WATER SAMPLING FIELD DATA SHEET INSTRUCTIONS
1. Sample ID - Sample ID number CCC_LLLLLL_MMM_YYDDD (Sample ID should also be recorded on the sample label.
Where: CCC - Country 3 letter abbreviation code.
LLLLLL - Camp abbreviation (i.e. first six letters of camp name).
MMM - Water sample number for that camp on that particular day (e.g. 01W, 02W, 03W, etc.)
YYDDD - jday code, last two digits of the year & three digit julian day of the year (e.g. 05015 for 15-Jan-2005).
2. Country - Country in which location or camp is located.
3. Location - Camp or location of sample.
4. Site - Specific site where sample was collected (i.e. PX, building 51, etc.), if applicable.
5. Operation - Name of operation ongoing in the area of the sample [e.g. Operation Iraqi Freedom (OIF), etc.] if applicable.
6. Sample Date - Date sample was collected (e.g. 20010515). (Sample Date should also be recorded on the sample label.)
7. Sample Time - Time sample was taken (e.g. 16:00). (Sample Time should also be recorded on the sample label.)
8. Collecting Unit - Unit collecting the sample (e.g. AML, 71st MEDDET, NEMPU2 etc.).
9. Collector's Name - The name of the person collecting the sample.
10. Collector's Phone No. - The phone number of the person collecting the sample.
11. Collector's Email - The email address of the person collecting the sample (e.g. john.doe@us.army.mil).
12. Percent of Personnel Exposed - What percentage of servicemembers at the site could be exposed to the water source?
13. Exposure Duration - How long are servicemembers expected to stay at the location where the sampling is being conducted?
14. Exposure Notes - Any notes or comments related to servicemember's exposure to the sampled water.
15. Water Type - (Select One and Complete 15a-15d) ROWPU - Water treated by a Reverse Osmosis Water Purification Unit
(ROWPU). Municipal - Water treated by a municipal process (e.g. coagulation, flocculation, settling, filtration, etc.).
Disinfected Fresh - Untreated fresh water (e.g. well water) that has been disinfected. Bottled - Water bottled by a DOD commercial
supplier.
Water Type
ROWPU, Municipal, Disinfected Fresh
Bottled
Operating Unit: Military, Contractor or Civilian unit
Manufacturer: Bottled water manufacture
operating the water treatment
(e.g. Coca-Cola)
15a
Bottling Location: Location where water was
Source of Water: The source of the water being
15b
treated (e.g. river, lake, town name)
bottled.
Primary Treatment: (e.g. coagulation, flocculation,
Brand: Bottled water brand (e.g. Dasani)
15c
settling, filtration, etc)
ROWPU ID: The ROWPU unit serial number
Lot#: Lot number of bottled water sampled
15d
16. Collection Point - Actual place where sample is collected. (Select all that apply)
T - Tap/Faucet, B - Water Buffalo, WT - Water Tanker , WB - Water Blivet, DS - Distribution System, TF - Treatment Facility,
ROWPU - Reverse Osmosis Water Purification Unit.
17. Water Use - Is water used for drinking or non-drinking? [Select One. If 17.b (Secondary Drinking) is selected complete 18.
If 17.c (Non-Drinking) is selected complete 18. and 19.].
18. Identify the primary drinking water source(s): Provide description of the primary drinking water source(s).
19. Non-Drinking Uses - What are other uses of water? Select all that apply and add other uses not listed.
20. Estimated Drinking Rate - (Select One): Less than or equal to 5, greater than 5 or if known the estimated drinking rate in LPD.
21. pH - The initial pH of the water before the sample is taken or before preservatives are added, if known.
22. Turbidity - The initial turbidity of the water being sampled in NTU, obtained from on-site testing.
23. Temperature - The initial temperature of the water in degrees Celsius, obtained from on-site testing.
24. TDS - The initial total dissolve solids in milligrams per liter (mg/L), obtained from on-site testing.
25. Total Coliform - The initial total coliform count from on-site bacteriological testing.
26. FAC (free-available chlorine) - The initial FAC of the water being sampled in ppm, obtained from on-site testing.
27. Geolocation (Classified locations should not be entered. They should be sent to oehs@usachppm.army.smil.mil with Sample
ID). 27a. Latitude - Sample latitude location in decimal degrees [from GPS].
27b. Longitude - Sample longitude location in decimal degrees [from GPS].
27c. Datum - Datum from map or GPS used (e.g. WGS84, etc.).
27d. MGRS - Location in Military Grid Reference System from GPS, ten digit grid with grid square identifier. A MGRS is made up of
5 parts: 1) A zone, 2) latitude band, 3) MGRS square, 4) an easting, and 5) a northing (e.g. 34 T EN 12345 67890).
28. Sampling Site Graphic - Any graphical or pictorial description of the sampling site. May include digital picture(s) of the
sampling. Digital picture(s) should be sent to oehs@apg.amedd.army.mil with Sample ID.
29. Notes - Notes related items like 1) field measurements, 2) observations of the area, 3) water quality description, 4) water
distributions system, 5) unusual circumstance, weather, potential pollution sources, etc.
APD LC v1.00
DA FORM 7577, NOV 2005

Download DA Form 7577 Treated Water Sampling Field Data Sheet

634 times
Rate
4.3(4.3 / 5) 201 votes
ADVERTISEMENT
Page of 2