Form SFN60767 "Revised Total Coliform Rule Sampling Site Plan (Systems 1,000 and Fewer)" - North Dakota

What Is Form SFN60767?

This is a legal form that was released by the North Dakota Department of Health - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2015;
  • The latest edition provided by the North Dakota Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN60767 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form SFN60767 "Revised Total Coliform Rule Sampling Site Plan (Systems 1,000 and Fewer)" - North Dakota

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REVISED TOTAL COLIFORM RULE SAMPLING SITE PLAN (SYSTEMS 1,000 AND FEWER)
www.ndhealth.gov/mf
NORTH DAKOTA DEPARTMENT OF HEALTH
DIVISION OF MUNICIPAL FACILITIES
SFN 60767 (6-2015)
Public Water System (PWS) Name:
PWS Number: (ex: ND1234567)
N D
Operator Name:
One routine sample/month collected at approved routine sample sites.
Repeat samples will be collected within 5 service connections up/downstream of the
original total coliform positive sample site unless using alternative repeat sites.
Site ID #:
Physical Address or GPS Coordinates:
ZIP Code:
Site/Tap Description:
Additional Site Info: (If applicable)
RTCR
0
0
1
RTCR
0
0
2
RTCR
0
0
3
RTCR
RTCR
RTCR
RTCR
RTCR
RTCR
For Department Use Only:
Send this form and a map showing the sites to:
Division of Municipal Facilities
918 E. Divide Ave., 3rd Floor
Bismarck, ND 58501-1947
Telephone Number 701.328.5211
Fax Number 701.328.5200
* To submit more sites, use additional forms.
REVISED TOTAL COLIFORM RULE SAMPLING SITE PLAN (SYSTEMS 1,000 AND FEWER)
www.ndhealth.gov/mf
NORTH DAKOTA DEPARTMENT OF HEALTH
DIVISION OF MUNICIPAL FACILITIES
SFN 60767 (6-2015)
Public Water System (PWS) Name:
PWS Number: (ex: ND1234567)
N D
Operator Name:
One routine sample/month collected at approved routine sample sites.
Repeat samples will be collected within 5 service connections up/downstream of the
original total coliform positive sample site unless using alternative repeat sites.
Site ID #:
Physical Address or GPS Coordinates:
ZIP Code:
Site/Tap Description:
Additional Site Info: (If applicable)
RTCR
0
0
1
RTCR
0
0
2
RTCR
0
0
3
RTCR
RTCR
RTCR
RTCR
RTCR
RTCR
For Department Use Only:
Send this form and a map showing the sites to:
Division of Municipal Facilities
918 E. Divide Ave., 3rd Floor
Bismarck, ND 58501-1947
Telephone Number 701.328.5211
Fax Number 701.328.5200
* To submit more sites, use additional forms.