High School STEM Education - Assessing Drinking Water Quality and Contaminant Sources

TITLE OF INFORMATION COLLECTION:

High School STEM Education - Assessing Drinking Water Quality and Contaminant Sources (OMB Control Number: 2080-0083; EPA ICR Number 2521.19)

INSTRUMENT: Instrument script is attached below. Final online product will include mandatory OMB control number, expiration date, and burden statement.

1. Form Number:

2. OMB Control Number: OMB Control Number: 2080-0083

3. Expiration Date:

The public reporting and recordkeeping burden for this collection of information is estimated to average 10 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, included through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed survey to this address.

Sample Identifier
Well/Spring/Sample Location Lat/Long (mynasadata.larc.nasa.gov)
Water use: Human or animal consumption, crops	(H, A, and/or C)
Well Type (hand dug, bored, drilled, driven, don't know)	(HD, B, Dr, Drv, DK)
Well Depth	(ft)
Screen Length	(ft)
Depth to Screen	(ft)
Well Casing Material (steel, galvanized, steel and plastic, PVC, don't know	(S, G, S/P, PVC, DK)
Well Grouted	(Y, N)
Plumbing Material (lead, copper, galvanized, PVC/PEX, other)	Pb, Cu, G, PVC/PEX, O)
Septic System	Y/N
Distance between well and septic tank/drainfield	(ft)
Identify other potential sources of contamination nearby
Distance between well and other potential source of contamination	(ft)
Last time water tested ( # of years, never, don't know)	(Y, N, DK)
Is water disinfected?	(Y/N)