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PRIVATE WELL TESTING ACT PROGRAM - page 58 / 75

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    If total coliform bacteria are detected then additional analyses are required to determine the specific type (fecal or E. coli)

present. Fecal coliform or E. coli analysis are not required if total coliform sample results indicate the absence of total coliform bacteria. ** The results of a "flushed" raw (untreated) water sample, which is required by the Private Well Testing Act regulations, should be compared to the Ground Water Quality Standard of 5 ug/l found at N.J.A.C.7: 9-6 et seq. The Lead Action Level of 15 ug/l applies to a one liter first-draw tap sample collected from a cold water kitchen or bathroom tap/sink in which the water has remained motionless in the plumbing system for at least six hours [40 CFR 141.86(b)(2)]. This type of standing-water sample is NOT required by the Private Well Testing Act regulations.

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    Arsenic analysis is required only in Bergen, Essex, Hudson, Hunterdon, Mercer, Middlesex, Morris, Passaic, Somerset and Union

Counties. A new MCL of 5 ug/l (ppb) took effect on January 23, 2006. ^ Mercury analysis is required only in Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Monmouth, Ocean, and Salem Counties. ~ Gross alpha particle activity testing will be required in Cumberland and Gloucester Counties starting March 15, 2003; Atlantic, Burlington, Camden and Salem Counties starting September 16, 2003; Cape May, Hunterdon, Mercer, Middlesex, Monmouth and Ocean Counties starting March 16, 2004. If the initial Gross alpha particle count exceeds 5 pCi/l a second count is required according to the Method. The MCL for Gross alpha particle activity is 15 pCi/l.

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Sample ID Number:

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Sample ID Number:

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Sample ID Number:

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Sample ID Number:

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Sample ID Number:

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

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Date/Time Sample Analyzed:

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Date/Time Sample Analyzed:

Date/Time Sample Collected: ____________

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Date/Time Sample Analyzed:

Volatile Organics: Date/Time Sample Collected: ____________

Inorganics: Date/Time Sample Collected: ____________

ADDITIONAL SAMPLE INFORMATION: Coliform Analyses: Date/Time Sample Collected: ____________ ____________

Date/Time Sample Analyzed:

Date/Time Sample Collected: ____________

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Date/Time Sample Analyzed:

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Date/Time Sample Analyzed:

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Date/Time Sample Analyzed:

pH Analysis: Date/Time Sample Collected: ____________

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Gross Alpha Analyses: Date/Time Sample Collected: ____________

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Sample ID Number:

Sample ID Number:

Date(s) All Analyses Received by Reporting Lab from Subcontracted Lab (if applicable):

CERTIFICATION OF RESULTS:

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