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Sample Siting Plan <br /> Information Required <br /> Name of System <br /> Owner(s) <br /> Number of Residences or Average Number of Persons Served per Month <br /> Name of Certified Laboratory <br /> A * �, - g c,, &' <br /> Name(s) of Sampler(s) if not Laboratory Personnel <br /> Name(s) and Phone Number(s) of Person(s) Laboratory are to Contact Following <br /> Any `Positive Sample: <br /> Day lV l 7 l T <br /> Contact #1 <br /> 1 Night ` <br /> �\0)2W Day 9 <br /> Contact # <br /> Night (lot C? -lq LA C-j <br /> Bacteriological monitoring frequency: <br /> Monthly: X Quarterly: Seasonal: (elaborate below) <br /> Monthly from: Quarterly from: <br /> Addresses or Locations of Routine and Repeat Sample Sites <br /> Routine #1 -cA-\ ,� h <br /> Repeat #1 K A-crh.Q„rti <br /> Repeat #2 �Oc..QSrjQ.. <br /> Repeat #3 Cs�r•A�!— < W�l`OflM <br /> Repeat #4 �Q.1 ` pY1 e—P t11� <br /> Routine #2 <br /> Repeat #1 <br /> Repeat #2 <br /> Repeat #3 <br /> Repeat #4 <br /> Submitted by: Date: <br />