Form LIC 9275. External Water Sampler Self-Certification Form

The LIC 9275 form is an external water sampler self-certification form used by the California Social Services agency. The main purpose of this form is to certify that a water sample has been collected in compliance with state regulations and to provide documentation of the sampling process.

The form consists of several parts, including personal information about the sampler, details about the location and type of sample collected, and a certification statement. Important fields include the date and time of the collection, the type of test being conducted, and any additional notes or instructions.

When filling out the form, it is important to ensure that all required fields are completed accurately and completely. Supporting documents may need to be attached, such as lab reports or documentation of previous sampling.

Examples of when this form may be used include testing for lead, copper, or nitrates in drinking water, or checking for bacterial contamination in recreational waters. It is essential to maintain accurate records of water sampling to ensure compliance with state regulations and to protect public health.

Strengths of this form include its ability to provide a clear and concise record of water sampling and its compliance with state regulations. Weaknesses may include the potential for errors or omissions in the data reported, as well as the burden of maintaining accurate and up-to-date records over time.

Alternative forms or analogues to LIC 9275 may include similar certifications used by other agencies or private laboratories. However, these forms may not have the same legal authority or specificity as LIC 9275.

Submitting the form will typically involve providing a copy to the appropriate regulatory agency responsible for overseeing water quality. The form may be stored electronically or in paper form, depending on agency policies and procedures.

Overall, LIC 9275 serves as an important tool for ensuring compliance with state regulations and protecting public health through accurate and complete water sampling documentation. Accurately completing the form can provide peace of mind for both samplers and regulatory agencies.