ABCDEFGHIJ
1
Lead Testing in Schools and Child Care Facilities: Phase 2- School Sampling and Testing
2
Sampling Plans
3
4
Building Name:Sampler's Name:Service line material:
5
Building/ License ID:
1234Sampler's Email:# of Students:
6
Building Address:Sampler's Phone:# Fixtures tested:
7
Public water system ID:Building Year Built:# Samples exceeding 5 ppb:
8
Outlet Type Codes:
9
DW= Drinking water fountain, WC= Water Cooler, CF=Classroom Faucet, KF=Kitchen Faucet, BF=Bathroom Faucet, NS=Nurse Office Sink, SC= Service Connector
10
11
Collection Type Codes:
12
I=Initial first draw, F=Flush sample, SS=Sequential Sample
13
*Sample Name is formulated to be created for you as: Sample # - Room # - Outlet Type - Collection Type
14
Sample DateTimeSample #Room #Outlet TypeCollection TypeSample Name*Location NotesLead Concentration (ppb)
15
10/15/20215:00 AM1K1SCI1234-1-K1-SC-IMop Sink for Service Line
16
10/15/20215:05 AM2K1KI1234-2-K1-K-IKitchen Kettle
17
10/15/20215:10 AM3K1KI1234-3-K1-K-IKitchen Ice Machine
18
10/15/20215:15 AM4K1KFI1234-4-K1-KF-IKitchen Sink Island
19
10/15/20215:20 AM5K1KFI1234-5-K1-KF-IKitchen Sink East
20
10/15/20215:25 AM6C1DWI1234-6-C1-DW-ICafeteria West Upper Drinking Fountain
21
10/15/20215:30 AM7C1DWI1234-7-C1-DW-ICafeteria West Lower Drinking Fountain
22
10/15/20215:35 AM8C1DWI1234-8-C1-DW-ICafeteria East Upper Drinking Fountain
23
10/15/20215:40 AM9C1DWI1234-9-C1-DW-ICafeteria East Lower Drinking Fountain
24
10/15/20215:45 AM10G1DWI1234-10-G1-DW-IGym West Water Fountain
25
10/15/20215:50 AM11G1DWI1234-11-G1-DW-IGym West Bottle Filling Station
26
10/15/20215:55 AM12G1DWI1234-12-G1-DW-IGym East Water Fountain
27
10/15/20216:00 AM13G1DWI1234-13-G1-DW-IGym East Filling Station
28
10/15/20216:05 AM14FieldHI1234-14-Field-H-IOutdoor Sports Field Yard Hydrant
29
10/15/20216:10 AM15HallDWI1234-15-Hall-DW-IDrinking Fountain Outside of 4C
30
10/15/20216:15 AM16HallDWI1234-16-Hall-DW-IDrinking Fountain Outside of Art Room
31
10/15/20216:20 AM17HallDWI1234-17-Hall-DW-IDrinking Fountain Outside of 4F
32
10/15/20216:25 AM18T1KFI1234-18-T1-KF-ITeacher's Lounge Room Sink
33
10/15/20216:30 AM19HallDWI1234-19-Hall-DW-IDrinking Fountain Outside of 3A
34
10/15/20216:35 AM20HallDWI1234-20-Hall-DW-IDrinking Fountain Outside of 3F
35
10/15/20216:40 AM21HallDWI1234-21-Hall-DW-IDrinking Fountain Outside S Auditorium
36
10/15/20216:45 AM22HallDWI1234-22-Hall-DW-IDrinking Fountain Outside N Auditorium
37
10/15/20216:50 AM23HallDWI1234-23-Hall-DW-IDrinking Fountain Outside Library
38
10/15/20216:55 AM24K5CFI1234-24-K5-CF-IK5 Sink
39
10/15/20217:00 AM25K3CFI1234-25-K3-CF-IK3 Sink
40
10/15/20217:05 AM26K6CFI1234-26-K6-CF-IK6 Sink
41
10/15/20217:10 AM27K4CFI1234-27-K4-CF-IK4 Sink
42
10/15/20217:15 AM28K1CFI1234-28-K1-CF-IK1 Sink
43
10/15/20217:20 AM29K2CFI1234-29-K2-CF-IK2 Sink
44
10/15/20217:25 AM30HallDWI1234-30-Hall-DW-IDrinking Fountain Outside of 1A
45
10/15/20217:30 AM31HallDWI1234-31-Hall-DW-IDrinking Fountain Outside of 1G
46
10/15/20217:35 AM32HallDWI1234-32-Hall-DW-IDrinking Fountain Outside of 2A
47
10/15/20217:40 AM33HallDWI1234-33-Hall-DW-IDrinking Fountain Outside of 2G
48
10/15/20217:45 AM34HallDWI1234-34-Hall-DW-IDrinking Fountain Outside of 5F
49
10/15/20217:50 AM35HallDWI1234-35-Hall-DW-IDrinking Fountain Outside of 6A
50
10/15/20217:55 AM36HallDWI1234-36-Hall-DW-IDrinking Fountain Outside of 5C
51
10/15/20218:00 AM37HallDWI1234-37-Hall-DW-IDrinking Fountain Outside of 6G