Get Private Water Instructions And Sample Form - Alabama Department ... - Adph

Filling out the Private Water Instructions and Sample Form for the Alabama Department of Public Health is a crucial step in ensuring the safety of drinking water. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering the Public Water System Identification Number (PWSID), which is assigned by the ADEM Water Division. Please note that this is not applicable for private wells.
3. Provide the collector’s name, which is the name of the person who gathered the water sample.
4. In the system served section, enter the legal name of your water system accurately.
5. Indicate the county where your water system office is located, or for private wells, the county where the well is situated.
6. Fill out the time collected using a 24-hour clock format. For example, 3:45 PM should be entered as 1545.
7. Enter the date collected using two digits for the month, day, and year, formatting it as MMDDYY (e.g., June 9, 2010 would be 060910).
8. Specify the collection points by indicating the location where each sample is gathered. Ensure that these numbers match those on the corresponding samples.
9. Indicate the chlorine residual at the collection point in milligrams per liter—this is not necessary for private wells.
10. For each sample type, circle the appropriate letter in the sample code section to identify the type of sample collected.
11. Provide the address where you want the final report mailed.
12. Avoid filling in any areas that are shaded on the form, as these are designated for lab use only.
13. Ensure correct shipping by using the address on the front for all deliveries to the Mobile Lab, and for USPS to the Montgomery Lab, use the designated address.
14. After filling out the form, you can save your changes, download a copy, print it, or share it as necessary.

Complete your Private Water Instructions and Sample Form online today for accurate and timely processing.