Attachment B Lead and Copper Sampling Plan.xlsx
XLSX spreadsheet 62 KB Posted
- Attached to
- B533--Potable Water Testing Federal contract opportunity
- Solicitation number
- 36C25926Q0620
About this file
This is a Lead and Copper Sampling Plan attachment for the VA Medical Center SLC water system (System #UTAH18173, population 3,295), which supports the Department of Veterans Affairs solicitation 36C25926Q0620 for potable water testing services. The document is a completed worksheet establishing the sampling framework required under the Lead and Copper Rule (LCR) per Utah Administrative Code R309-210-6 and demonstrates compliance with federal water quality monitoring requirements.
The VA Medical Center SLC is classified as a small water system (3,301-10,000 population equivalent) requiring 20 routine sampling sites and 10 alternate sites under standard monitoring protocols. The facility has identified 10 completed routine sample sites (LC001-LC010) representing buildings constructed between 1949 and 2011, with all sites featuring copper plumbing materials and verified plumbing conditions. Sites LC011-LC017 show incomplete entries, while LC018-LC152 remain blank. All routine sites identified to date have received sampling instructions. The sampling plan includes one associated facility: SLC VA Day Care (built 1949, located at 500 Foothill Drive) with no lead service lines. The plan requires 100% plumbing verification for all identified tiers and mandates that if lead service lines are present, 50% of samples must be collected from areas served by those lines. This sampling framework directly supports the contractor requirements under solicitation 36C25926Q0620 to collect potable water samples at the George E Wahlen Veterans Medical Center for microbial, chemical, and water quality testing, including lead and copper analysis.
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Text version
Intro Lead and Copper Sample Site Submission Form
The Lead and Copper Rule (LCR) requires all community and non-transient non-community water systems to sample at locations that may be particularly susceptible to high lead or copper concentrations in accordance with Utah Administrative Code R309-210-6. The LCR establishes a tiering system for prioritizing sampling sites. A materials evaluation is required to help classify sampling sites into tiers. Water system owners and operators must perform a materials evaluation prior to lead and copper tap monitoring. This form defines the monitoring requirements, tiering system for prioritizing sampling sites, and includes a site selection certification form for submittal to the Department. This form is intended to help with site selection.
| Enter System Name, Number, and Population | |
| System # | UTAH18173 |
Matthew Wycoff: Input your system's identification number. Example Utah 12345 System Name VA Medical Center SLC Matthew Wycoff: Input the name of your water system Population (from waterlink.utah.gov) 3295 Matthew Wycoff: Input your system's population. This number can be viewed at waterlink.utah.gov
| Table 1: Lead and copper Sampling Requirements | |||||
| A system may become eligible for a reduced monitoring schedule upon the completion of two consecutive rounds of standard sampling | |||||
| Size Category | System Size | Number of Sample Sites Required | |||
| Standard | Reduced | ||||
| Large | >100,000 | 100 | 50 | Your Requirement | |
| 50,001 to 100,000 | 60 | 30 | |||
| Medium | 10,001 to 50,000 | 60 | 30 | Standard | Reduced |
| 3,301 to 10,000 | 40 | 20 | 20 |
Matthew Wycoff: This is your system's sampling requirement for standard monitoring. Your system may become eligible for reduced monitoring upon the completion of two rounds of standard sampling.
Matthew Wycoff: This is your system's sampling requirement for reduced monitoring.
Matthew Wycoff: Input your system's identification number. Example Utah 12345
Matthew Wycoff: Input the name of your water system
| Small | 501 to 3,300 | 20 | 10 |
| 101 to 500 | 10 | 5 | |
| 100 or less | 5 | 5 | |
| Verification of Plumbing Materials | |||
| To identify sites that are at the highest risk for elevated lead and copper concentrations the construction and repair materials within your distribution system and the buildings connected to your system should be verified. 100% of tier 1 and 2 sites and 20% of tier 3 and representative sites must be verified in your sample site plan. Information on plumbing materials may come from the following sources: |
| Visual and physical inspection (perferred method) | Meter istallation records |
| Plumbing codes | Permit files |
| Plumbing permits | Existing water quality data |
| Distribution Maps and drawings | Interviews with personnel and inspectors |
| Inspection and maintenance records | Community surveys |
Click Here to Complete Site Sample Plan Form
Materials Worksheet Lead and Copper Rule Sample Site Plan Worksheet
| Water System Name | System Number | Totals | |
| VA Medical Center SLC | UTAH18173 | Routine | Alternate |
| 17 |
Matthew Wycoff: This number must be equal to the number of rountine sites required for your system. Alternate sites are used when a routine site is no longer available.
| Tier 1 | Tier 2 | Tier 3 | Representative | |||
| 0 | 0 | 0 | 10 | |||
| Number of Routine Sites Required: | Population | % Verified | % Verified | % Verified | % Verified | |
| 20 | 3295 | ERROR:#DIV/0! |
Matthew Wycoff: 100% of tier 1 and 2 sites must have their plumbing verified
ERROR:#DIV/0! ERROR:#DIV/0!
Matthew Wycoff: 20% of tier 3 and representative sites must have their plumbing verified
System Type
Matthew Wycoff: Input system type: Community or non-community non-transient
| Community Water System | ||||
| Tier 1 | Tier 2 | Tier 3 | Representative | |
| Single family residences with: | Buildings or multi-family Residences with: | Single family residences with: | No tiered site is available | |
| Lead pipes | Lead pipes | Copper pipes with lead solder installed before 1982 | Is an accurate repesentation of the average structure in the system | |
| Lead service lines | Lead service lines | |||
| Copper pipes with lead solder installed between 1982-1988 | Copper pipes with lead solder installed between 1982-1988 | |||
| Non-Community Non-Transient Water System | ||||
| Tier 1 | Tier 2 | Tier 3 | Representative | |
| Any building with: | Any building with: | Not applicable | No tiered site is available | |
| Lead pipes | Copper pipes with lead solder installed before 1982 | Is and accurate representation of the averge structure in the system | ||
| Lead service lines | ||||
| Copper pipes with lead solder installed between 1982-1988 | ||||
| Enter Your Sample Site Information in the Fields Below | ||||
| If lead service lines are present in the system %50 of the lead and copper samples must be taken in the areas served by those lines. Site selection must be made in order of priority. For example, all possible tier one sites must be used before a tier two site is selected and so on. A sufficient number of alternate sites should be indentified for use in the event that a routine site becomes unavailable. | ||||
| Type of Structure (Single family residence, Multi-family residence, Building) | Year built | Tier |
Matthew Wycoff: Select tiers based on the criteria presented in the table above
| Site ID # | |
| Matthew Wycoff: This is an identification number that is specific to the site. Each sample from this site should be marked with this number. These numbers should be verified on the lab's chain of custody form to ensure that each sample is associate with the correct site ID # | Location (address) |
Matthew Wycoff: Each address must be unique and no two sample ID #s can have the same address. If all the sites in your water system share the same mailing address than use a number or letter to set them apart. Example 555 main st. Yourtown, Utah 84000 Cabin A and the next site will be cabin B and so forth.
Contact LSL (Y/N) Matthew Wycoff: Is this site service by a lead service line?
Matthew Wycoff: 100% of tier 1 and 2 sites must have their plumbing verified Home Plumbing Material Plumbing Verified (Y/N) Matthew Wycoff: 100% of tier 1 and 2 sites and 20% of tier 3 and representative site must be verified. See page 1 of this form for verification instructions
Matthew Wycoff: 20% of tier 3 and representative sites must have their plumbing verified Site Type Received Sampling Instructions (Y/N) Matthew Wycoff: Did you issue sampling instructions to the person who will be taking the sample?
You can download instructions at waterlink.utah.gov
Matthew Wycoff: Select tiers based on the criteria presented in the table above
Matthew Wycoff: This number must be equal to the number of rountine sites required for your system. Alternate sites are used when a routine site is no longer available.
Matthew Wycoff: This is an identification number that is specific to the site. Each sample from this site should be marked with this number. These numbers should be verified on the lab's chain of custody form to ensure that each sample is associate with the correct site ID # Matthew Wycoff: Each address must be unique and no two sample ID #s can have the same address. If all the sites in your water system share the same mailing address than use a number or letter to set them apart. Example 555 main st. Yourtown, Utah 84000 Cabin A and the next site will be cabin B and so forth.
| 1/2/3/Rep | Name | Phone | Routine | Alternate | ||||
| BLDG | 1949 | Rep | LC001 | Building 1 - 1C03 | No | Copper | Yes | Routine |
| BLDG | 1949 | Rep | LC002 | Building 2 - 2A25 | No | Copper | Yes | Routine |
| BLDG | 1949 | Rep | LC003 | Building 3 - 1D07 | No | Copper | Yes | Routine |
| BLDG | 1949 | Rep | LC004 | Building 5 - 1A10 | No | Copper | Yes | Routine |
| BLDG | 1949 | Rep | LC005 | Building 13 - 1A08 Daycare | No | Copper | Yes | Routine |
| BLDG | 1981 | Rep | LC006 | Building 14 - 3A27 | No | Copper | Yes | Routine |
| BLDG | 2011 | Rep | LC007 | Building 32 - 1A19 | No | Copper | Yes | Routine |
| BLDG | 1949 | Rep | LC008 | Valor House - Mens Restroom 1st floor | No | Copper | Yes | Routine |
| BLDG | 1949 | Rep | LC009 | Retirement Home - West Hall Sink | No | Copper | Yes | Routine |
| BLDG | 2001 | Rep | LC010 | 550/590 Feed - 103-50 | No | Copper | Yes | Routine |
| BLDG | LC011 | No | Copper | No | Routine | |||
| BLDG | LC012 | No | Copper | No | Routine | |||
| BLDG | LC013 | No | Copper | No | Routine | |||
| BLDG | LC014 | No | Copper | No | Routine | |||
| BLDG | LC015 | No | Copper | No | Routine | |||
| BLDG | LC016 | No | Copper | No | Routine | |||
| BLDG | LC017 | No | Copper | No | Routine | |||
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Schools School and Daycare Facility Inventory List (Optional)
| System # | UTAH18173 | System Name | VA Medical Center SLC | ||||
| Type of Facility | Year built | Name of School or Daycare | Address | Contact | Lead service line | ||
| School, Daycare, Other | Name | Phone | Yes/No | ||||
| Daycare | 1949 | SLC VA Day Care | 500 Foothill Drive | No |
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