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Run: Lead and Copper Rule Tap Sampling Field Log

This field log captures lead and copper tap sampling at lead service line sites, including stagnation time, first-liter and fifth-liter collection, and chain...

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Site & Sampling Event Information

Sampling event date and start time recorded critical (required)

Record the date and time the sampling event began.

Site ID and service address documented critical (required)

Unique site identifier and service address for the sampling location.

Sampling purpose identified as Lead and Copper Rule / LCRI compliance critical (required)

Identify the reason for the sampling event.

Sampler name and organization recorded critical (required)

Name of the field sampler and employer/organization.

Site Conditions and Lead Service Line Verification

Lead service line site confirmed critical (required)

Confirm the site is a designated lead service line sampling location.

Yes No N/A

Sampling point is the designated kitchen or first-draw tap critical (required)

Confirm the sample was collected from the approved tap location.

Yes No N/A

Aerator, screen, or attachment condition documented

Document the condition of the faucet aerator, screen, or other attachment.

Site access and interior conditions noted

Record any access limitations or site conditions that may affect sampling.

Stagnation Time and Pre-Sampling Requirements

Stagnation start time recorded critical (required)

Time when water use ceased for the required stagnation period.

Stagnation duration meets sampling protocol critical (required)

Measured stagnation time before sample collection.

No water use occurred during stagnation period critical (required)

Confirm that no water was used at the tap during the stagnation period.

Yes No N/A

Pre-sampling flush or disturbance observed critical (required)

Confirm the tap was not flushed or disturbed before the first-liter sample was collected.

Yes No N/A

First-Liter Sample Collection

First-liter sample bottle ID recorded critical (required)

Unique identifier for the first-liter sample container.

First-liter sample collected from initial draw critical (required)

Confirm the first-liter sample was collected from the initial water draw at the tap.

Yes No N/A

First-liter collection time recorded critical (required)

Time the first-liter sample was collected.

First-liter sample volume verified critical (required)

Measured volume of the first-liter sample.

First-liter sample sealed and labeled critical (required)

Confirm the sample was sealed and labeled immediately after collection.

Yes No N/A

Fifth-Liter Sample Collection

Fifth-liter sample bottle ID recorded critical (required)

Unique identifier for the fifth-liter sample container.

Fifth-liter sample collected after first four liters discarded or routed per protocol critical (required)

Confirm the fifth-liter sample was collected according to the approved fifth-liter protocol.

Yes No N/A

Fifth-liter collection time recorded critical (required)

Time the fifth-liter sample was collected.

Fifth-liter sample sealed and labeled critical (required)

Confirm the sample was sealed and labeled immediately after collection.

Yes No N/A

Chain of Custody, Deviations, and Sign-Off

Chain-of-custody form completed and sample transfer documented critical (required)

Confirm the chain-of-custody record is complete for all collected samples.

Yes No N/A

Any deviations, non-conformances, or field issues documented

Record any protocol deviations, unusual site conditions, or issues affecting sample validity.

Inspector signature critical (required)

Signature of the person completing the field log.

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