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PRIVATE WELL TESTING ACT PROGRAM - page 57 / 75

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New Jersey Private Well Water Test Reporting Form

The New Jersey Private Well Test Reporting Form is a standardized form to be used exclusively by laboratories reporting well test results to their client in accordance with the Private Well Testing Act Regulations N.J.A.C. 7:9E.

These laboratory analyses were completed for the purposes of complying with the Private Well Testing Act

SUMMARY OF WELL WATER TEST RESULTS:

Required Test Parameters

Result

Units

Applicable Standard

(Maximum Contaminant Level, Action Level or Recommended Limit)

Standard

Laboratory

Exceeded

Certification

(Y/N)

ID #

Microbial Parameters

Total Coliform Fecal Coliform* E. coli*

Pres/Abs

Absent

Pres/Abs

Absent

Pres/Abs

Absent

ug/l

5 ug/l

ug/l

2 ug/l

ug/l

5 ug/l **

mg/l

0.3 mg/l

mg/l

0.05 mg/l

Metals

Arsenic# Mercury Lead** Iron Manganese General Chemistry pH Nitrate ^

pH units

ug/l

6.5-8.5

(optimum range)

10,000 ug/l

Volatile Organic Compounds Benzene Carbon Tetrachloride Chlorobenzene Dichlorobenzene (1,2-) Dichlorobenzene (1,3-) Dichlorobenzene (1,4-) Dichloroethane (1,1-) Dichloroethane (1,2-) Dichloroethene (1,1-) Dichloroethene (cis 1,2-) Dichloroethene (trans 1,2-) Methylene Chloride Dichloropropane Ethylbenzene Methyl tertiary-butyl ether Naphthalene Styrene Tetrachloroethane (1,1,2,2-) Tetrachloroethene Toluene Trichlorobenzene (1,2,4-) Trichloroethane (1,1,1-) Trichloroethane (1,1,2-) Trichloroethene Vinyl Chloride Xylenes (total)

ug/l

1 ug/l

ug/l

2 ug/l

ug/l

50 ug/l

ug/l

600 ug/l

ug/l

600 ug/l

ug/l

75 ug/l

ug/l

50 ug/l

ug/l

2 ug/l

ug/l

2 ug/l

ug/l

70 ug/l

ug/l

100 ug/l

ug/l

3 ug/l

ug/l

5 ug/l

ug/l

700 ug/l

ug/l

70 ug/l

ug/l

300 ug/l

ug/l

100 ug/l

ug/l

1 ug/l

ug/l

1 ug/l

ug/l

1,000 ug/l

ug/l

9 ug/l

ug/l

30 ug/l

ug/l

3 ug/l

ug/l

1 ug/l

ug/l

2 ug/l

ug/l

1,000 ug/l

Radiological Parameters

Gross Alpha

(initial)~

Gross Alpha

(final)~

PCi/l PCi/l

5 pCi/l~ 15 pCi/l

Not Applicable

UNITS: Pres/Abs=presence or absence; ug/l= micrograms per liter (also known as parts per billion); mg/l=milligrams per liter (also known as parts per million); pCi/l=picocuries per liter; su=standard units.

46

Analytical Method

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