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SAMPLE SmNG PLAN <br /> SAN JoAQuLN COUNTY ENVIRONMENTAL HEALTH dEPARTMIZNT <br /> French CaM12 Golf& RV 3901377 <br /> Name of Small Pubfic Water System(SPINS) PS C <br /> xle <br /> Jac-K V rderame <br /> C7wnar(s) <br /> 100 ervice <br /> Number of sconnections 700 Custorw <br /> Number Of customers <br /> ar W t <br /> Marne of CQrtified Laboratory Name of Sampler(ffnd L-911 -by '- <br /> 61 <br /> 1 -- <br /> «y)Certified by <br /> Name{s} and phone Number(s)of Person($} Laboratory are to Contact pvllowririg Any Positive Sample in Order <br /> of <br /> yt ndl�rrl C�g1Ce: <br /> BPWSContact2 � <br /> Day wl$ht�N <br /> email <br /> SPWS Contact(1$!2 13 } t_ <br /> Day NightlC�i1 <br /> e-mail <br /> (CDO/CTO)(1512 13 } Da 1 <br /> y NightlC�f <br /> email <br /> Bacteriological monitoring frequency:Monthly ZLtuatoarty_ � �: <br /> Monthly from: Quarterly from. <br /> Addresses or L-ocations of Routine and Repeat Sample Sites: <br /> Routine#1 Hose bib at r sta ra t <br /> The four Repeat samples shall be collected within 24 ?,ours <br /> following locations, usi numera tes m thuds with chi ne c3tion that the Routh" sample faded at ble <br /> 'du is l .; <br /> Repeat#1 5 irne asbove <br /> Repoat#2 RV clubhouse <br /> Repeat#3 Ho bib at m sho <br /> Repeat#4 Wellhead <br /> Routine#2 <br /> Repeat#1 <br /> Repeat#2 <br /> Repeat#3 <br /> Repeat#4 Wellh ad <br /> BY signing below, I hereby submit this sample siting plan and autfwze the above-mentioned State cent W laboratory to <br /> release and submit'copies of all analytical results for this water..system,to ttr San J uin <br /> IJepartment. `.. �a4 C-our'y EnvinDmOntal <br /> Health <br /> Submitted b <br /> y ' Date; <br /> "Owner or Operatprshall notify the EHD any positive <br /> ReP88t or Er4K�'OWn tyy tris end d the day. <br />