1.                  Remove screen from faucet.

2.                  Run water hard for 5 minutes.

3.                  Do not touch inside of bottle cap or opening of bottle.

4.                  Turn water down, fill bottle.

5.                  Parts of form to compete:

Sample # - Number is located on bottle (No problem if the bottle has not been assigned 
             a  number—will be assigned one by office and/or lab).

Date and Time Collected

Sampler (First and Last name)

Mail Report To (Should be stamped with Modoc County Health Dept.’s address)

Phone Number

Address Sample Taken

Location of Sampling Point (Example: Kitchen faucet, bathroom faucet, well, etc)

Type of Sample (Most tests are for Drinking Water)

Test Desired (Should be marked Coli-Lert unless instructed otherwise)

The lab must receive the water sample within 24 hours.  If you would like Environmental Health to mail the water sample, please drop off the sample before 11:00 A.M.  (Water samples are picked up by courier by 12:00 P.M., approximately)

DO NOT TAKE THE WATER SAMPLE ON THURSDAY OR FRIDAY—THE LAB IS CLOSED ON THE WEEKEND.  The best time to take your water sample is on Monday or Tuesday.

If you would prefer to mail the sample yourself, the postage is $2.59.

The fee for the water sample test is $20.00.  Make all checks payable to SHASTA COUNTY HEALTH DEPARTMENT.  Enclose the check in the water sample container.