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PRIVATE WELL TESTING ACT PROGRAM - page 56 / 75

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SAMPLE INFORMATION: Sample Collector Name:

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Authorized Representative/Certified Laboratory Employee Lab Certification ID #:

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Sample Type: NOTE: Only raw or untreated water samples meet the requirements of the PWTA regulations N.J.A.C. 7:9E.

a.) Indicate Specific Location of Sample Collected:

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b.) Type of Treatment Device(s) Installed (if known): ___________________________________________________________________

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    Primary Drinking Water contaminants are those contaminants that have Maximum Contaminant Levels or Action Levels

established to protect health. The Primary Drinking Water contaminants are coliform bacteria, nitrate (total), lead, the volatile organic compounds, arsenic, mercury and gross alpha. The standards for primary contaminants are the maximum permissible levels allowed in drinking water based on ingesting the drinking water over the course of a lifetime. ++ Secondary Drinking Water contaminants are those contaminants that have Recommended Upper Limits or Optimum Ranges established to protect against those properties that adversely affect the taste, odor, or appearance of drinking water. The Secondary Drinking Water contaminants are iron, manganese and pH.

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