AquaSquad™ member name: __________________________________________________
I.D. number: ________________
Location: ____________________________________________________________________
Sample data: _______________________________________________
Location: __________________________________________________
Address: __________________________________________________
City: _____________________________________________________
State: __________________
Country: _________________________________
Postal code: ___________________

Name of body of water: _______________________________________________________
Class: ________________
River: ____________________________________________________
Stream: __________________________________________________
Lake: ____________________________________________________
Estimated flow: ___________________
Size: _________________
Volume: ______________

Source of pollution: __________________________________________________________
Sanitary: ________
Industrial: _______
Types of industries: __________________________________________________________
How many of each: __________________________________________
List: ______________________________________________________________________
Number of people using water source: ___________________

Physical:
Temperature: ______________
Color: _____________
Odor: _____________
Visible oil sheen: yes ______ No ______

Sample Collection Vials

NOTES:

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