Water System Sampling Form — June 2025

Microbiological Samples and Free Chlorine Residual

|Sample Location ee ee|Date of Sample ee ee|Sample Type

1. Routine
2. Repeat ee ee|Total Coliform Positive ee cae|E.coli Positive ee ee|Free Chlorine Residual (mg/l) ee CO ee ee|Population Served: ee CO|Population Served: ee CO|2,730 ee|2,730 ee|ee|ee| |---|---|---|---|---|---|---|---|---|---|---|---| |||||||ee CO|||||| |||||||Number of microbiological monitoring samples required: ee CO ee|||||3 ee ee| |Traditions Garden Hydrant ee ee ee|6/30/2025 ee ee|1 ee ee ca|Yes No ee cae ca|Yes No ee ee kn|0.54 ee ~~ ee ee Gee|ee ee|ee ee|ee ee|ee|ee|ee ee| |||||||Number of microbiological monitoring samples taken: ee es eeGnGG|||||3 ee es| |3 Cambridge ee ee a|6/30/2025 ee ~~ a|1 ee ~~ ca a|Yes No cae ~~ ca a|Yes No ee kn ic|0.90 ee ee Gee A|Did an M&R violation occur? ee es eeGnGG a ee|||Yes es GG|No es|ee es| |||||||es ee a Gn|es Gn ee Gn|es GG Gn|es GG|es|es| | Abrahams Park Hydrant | 6/30/2025 | 1 | Yes | Yes | 0.49 | If “Yes,” check reason(s)below: | - | - | es | es | es | | ee | a | ca | No | No | Gee | es | - | - | GG | - | - | | a | - | a | ca ~~ | kn | A | eeGnGG | - | - | - | - | - | | - | - | - | a | ic | - | a | - | - | - | - | - | | - | - | - | - | - | - | ee | - | - | - | - | - | | - | - | - | - | - | - | Gn | - | - | - | - | - | | - | - | - | - | - | - | ee | - | - | - | - | - | |||||||a Gn ee|Actual number of samples is fewer than required. ee Gn||||| |fe ee ee|a fe |a fe tan|Yes No a ~~ fe tan|Yes No ic ~~ fe aidan|A fe rere|Gn ee fe|Did not collect/analyze repeat sample. Gn fe|||fe|fe| |||||||fe fo [| rere|Did not collect/analyze for E. coli for positive total coliform from routine/repeat sample. fe fo [| rere ==||||fe fo [|| |ee ee ee|ee|tan near|Yes No tan near|Yes No aidan aes|rere ferns|fo [| rere|||||fo [|| |||||||Did an MCL violation occur? [| rere erns||||Yes No == erns|[| erns| |ee ee ee ee ee|ee ee|tan near ee ee|Yes No tan near ee Geeta|Yes No aidan aes ee ok|rere ferns ee|[|~~ rere erns|[| rere erns|rere erns|rere erns|== erns|[| erns| | If “Yes,” check reason(s) below (see also Part 5, Table 6 for additional | - | - | - | - | erns | | information). | - | - | - | - | PO | | rere | - | - | - | - | - | | = = | - | - | - | - | - | | erns | - | - | - | - | - | | PO | - | - | - | - | - | | — | - | - | - | - | - | | ee ee | ee | tan | Yes | Yes | rere | - | - | - | - | - | erns | | ee | ee | near | No | No | ferns | - | - | - | - | - | PO | | ee | ee | ee | tan ~~ | aidan | ee | - | - | - | - | - | - | | - | - | ee | near ~~ | aes | es | - | - | - | - | - | - | | - | - | - | ee | ee | - | - | - | - | - | - | - | | - | - | - | Geeta | ok | - | - | - | - | - | - | - | | - | - | - | oc | cece | - | - | - | - | - | - | - | |||||||PO — es|For systems collecting less than 40 samples per month: two or more of the samples (routine and /or repeat) are positive for total coliform (= total coliform MCL violation). PO||||| |ee ee|ee ate|ee ate|Yes No Geeta oc ate|Yes No ok cece iat|es ee|— es|||||| |||||||— esa ee|||||| |ee ee a|ee ate ee|ee ~~ ate ee|Yes No Geeta ~~ oc ~~ ate ee|Yes No ok cece iat e|es ee ee|— esa ee ||For systems collecting 40 or more samples per month: more than 5% of the samples (routine and/or repeat) are positive for total coliform (= total coliformMCL violation). Kj —“‘“_OC—sS||||| |||||||a ee | e|||||| |ee a ee ee|ate ee ee|ate ee ante|Yes No ate ~~ ee ante|Yes No iat e cere|ee ee cers|a ee eKj|||||| |||||||eKj cers|The original sample was E.coli positive and at least 1 repeat sample was positive for total coliform ( =E.coli MCL violation ). Kj —“‘“_OC—sS cers(aE||||| |a ee ee ee|ee ~~ ee ee|ee ~~ ante ee|Yes No ee ante ee|Yes No e cere ee|ee cers ee|eKj cers|||||| |||||||Kj cers ee|Kj cers ee|(aE ee|—“‘“_OC—sS (aE ee|—“‘“_OC—sS ee|—“‘“_OC—sS ee| | ee ee | ee | ante | Yes | Yes | cers | Reminder: System must collect a minimum of five (5) routine microbiological | | ee | ee | ee | No | No | ee | monitoring samples during the month following a repeat sample collection. | | ee | ee | Gant | - | - | ferry | Kj | | - | - | - | ante | cere | - | —“‘“_OC—sS | | - | - | - | ee | ee | - | cers (aE | | - | - | - | Gantar | Gata | - | ee | | - | - | - | - | - | - | ferry ersGers Ge | |ee ee|ee ee|ee Gant|Yes No ee Gantar|Yes No ee Gata|ee ferry||||||| |||||||ee ferry ers|ee ers|ee Gers Ge|ee Ge|ee|ee| |ee ~~ se|ee se|Gant se|Yes No Gant ar ~~ se|Yes No Gata se|ferry|ferry ers|ers |Gers Ge|Ge||| |||||||As required by 5-1.72, “Operation of a Public Water System,” a copy of this form shall be sent to your local health department by the 10th calendar day of the next reporting period. > YY|||||| |ee|||Yes No ee|Yes No ee|ee||||||| |fe ee|fe ==|fe ==|Yes No fe ee ==0|Yes No fe ee ==|fe ee GG|fe >|fe >|fe|fe YY|fe YY|fe| |||||||fe > GG|fe > GG|fe|fe YY|fe YY|fe| |ee|==|==|Yes No ee ==0|Yes No ee ==|ee GG|> GG a|> GG ee||YY|YY|| |||||||> GG a|> GG ee||YY|YY|| |ee fe|== fe|== fe|Yes No ee == 0 ~~ fe|Yes No ee == fe|ee ~~ GG fe|> GG a fe ee|> GG ee fe ee|fe|YY fe|YY fe|fe| |||||||fe ee|fe ee|fe|fe|fe|fe|

Did an emergency or low pressure problem occur? Did source water bypass an existing treatment process in the system? If so, please explain.

Comments:

DOH-360 (02/05) Page 2 of 2