United States
        Environmental Protection
        Agency
Office of Water
(WH-550)
EPA812/B-92-005
May 1992
vvEPA   LEAD AND COPPER
        MONITORING GUIDANCE for
        WATER SYSTEMS SERVING

        501 to 3,300 PERSONS
   oo
                     HEADQUARTERS I. !BRW
                     ENV'W •:'.<• VfAiPiJfvrrTiON AGENCY

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        Lead and Copper
      Monitoring Guidance
                  for
     Water Systems Serving
      501 to 3,300 Persons
              ******
Definitions
Introduction
Conduct a Materials Evaluation to Identify Lead
and Copper Sampling Sites
How and When You Should Collect Lead and
Copper Tap Water Samples
How and When You Should Collect Water Quality
Parameter Samples
How and When You Should Collect Lead and
Copper Source Water Samples
Schedules
Sample Forms and Worksheets

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              Definitions Applicable to the

                  Lead and Copper Rules

•  ACTION LEVEL (AL) is the concentration of lead or copper in water which determines
   the treatment requirements contained in Subpart I of this part that a water system is
   required to complete. The lead action level ia  15 ppb measured in  the 90th
   percentile. The copper action level is 1.3 ppm measured in the 90th percentile.
   See page 13 for calculation.

•  BLDGs means public or commercial buildings served by the PWS.
*  BLDG>82  means a public  or commercial building constructed after 1982 with copper
   plumbing using lead-based solder.
•  BLDG<82  means a public  or commercial building constructed before or in 1982 with
   copper plumbing using lead-based solder.
•  BLDG-LSL means a public or commercial building served by a lead  service line
   connection.
•  BLDG-Pb means a public or commercial building which has lead interior plumbing.
*  CORROSION INHIBITOR means a substance capable of reducing the corrosivity of
   water toward metal  plumbing  materials, especially lead  and  copper, by forming a
   protective film on the interior surface of those materials.

•  Cu is the symbol for copper.
•  EFFECTIVE CORROSION INHIBITOR RESIDUAL means a concentration sufficient
   to form a passivating  film on the interior walls of a pipe.
*  FIRST DRAW SAMPLE means a one-liter sample of tap water, collected in accordance
   with §141.86(b)(2),  that has been standing in plumbing pipes at least 6 hours and is
   collected without flushing the tap.
•  LARGE WATER SYSTEM means a water system that serves more than 50,000 persons.
•  LEAD SERVICE LINE (LSD means a service line made  of lead which connects the
   water main to the building inlet and any lead pigtail, gooseneck or other fitting which is
   connected to such lead line.
•  MAXIMUM CONTAMINANT LEVEL (MCL) means the maximum permissible level of
   a contaminant in water which is delivered to any user of a public water system.
•  MEDIUM-SIZE WATER SYSTEM means a water system that serves greater than 3,300
   and less than or equal to 50,000 persons.
•  MFR>82 is the acronym for a multi-family residence constructed after 1982  with copper
   plumbing using lead-based solder.
*  MFR<82 is the acronym for multi-family residences constructed before or in 1982 with
   copper plumbing using lead-based solder.
•  MFR-LSL  is the acronym  for multi-family residences served by a lead service line
   connection.
•  MFR-Pb is the acronym for multi-family residences which have lead interior plumbing.
•  MFRs is the acronym for multi-family residences.

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NRs is the acronym for non-residential structures constructed as single-family residence.

OPTIMAL  CORROSION CONTROL TREATMENT  means  the  corrosion control
treatment that minimizes the lead and copper concentrations at users' taps while insuring
that the treatment does  not cause the water system to  violate  any national primary
drinking water regulations.
NTNCWS is the acronym for a Non-Transient, Non-Community Water Supply

Pb is the symbol for lead.
Pb/Cu-POE means lead and copper samples collected at the points of entry to the
distribution system representative of each source of supply after treatment.
Pb/Cu-TAP means lead  and copper samples  collected as first-draw tap samples from
targeted sample sites.
POE is the acronym for points of entry to the distribution system  representative of each
source of supply after treatment.
PQL is the acronym for the Practical Quantitation Level

PWS is the  acronym for a Public Water Supplier
SERVICE LINE SAMPLE means a one-liter sample of water, collected in accordance
with §141.86(b)(3), that has been standing for at least 6 hours in  a service line.
SFRs is the acronym for single family residences, which can include for purposes of
identifying targeted sampling locations: (1) Non-Residential structures (NRs); and (2)
Multi-Family Residences (MFRs) if they  constitute more than 20%  of the  service
connections  within the PWS's service area.
SFR>82 is the acronym for a single-family residence constructed after 1982 with copper
plumbing using lead-based solder.
SFR<82 is the acronym for a single-family residence constructed before or in 1982 with
copper plumbing using lead-based solder.
SFR-LSL  is the acronym for a single-family residence served by a lead service line
connection.
SFR-Pb is the acronym for a single-family residence which have lead interior plumbing.
SINGLE FAMILY  STRUCTURE means a  building constructed as a single-family
residence that is currently used as either a residence  or a place of business.
SMALL WATER SYSTEM means a water system that serves 3,300 persons or fewer.

90%TL means the 90% lead and/or copper level.
90%TL-POE means the difference between the 90% lead level for first-draw tap samples
collected at targeted sample sites and the highest respective lead level measured at the
points of entry to the distribution system.
WQP means a water quality parameter, which includes pH, temperature, conductivity,
alkalinity, calcium, orthophosphate, or silica.
WQP-POE  means water quality parameters  measured at the points of  entry to the
distribution system representative of each source of supply after treatment.
WQP-DIS means lead and copper measured at representative locations throughout the
distribution  system.

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Page 1 — Monitoring Guidance for Public Water Systems
            Monitoring Requirements
  The  U.S.  Environmental Protection
Agency promulgated National Primary
Drinking Water Regulations (NPDWRs)
for lead and copper on June 7, 1991
(56 FR 26460).
  Three   monitoring  protocols  are
included in the final rule: (1) tap water
monitoring for lead and copper; (2) water
quality  parameter (WQP) monitoring;
and (3) source water monitoring for lead
and copper.
  The monitoring requirements for non-
transient, non-community water systems
(NTNCWSs) are essentially the same as
those for community  water  systems
(CWS). Please refer to 40 CFR §141.86
(a)(6) and (7) for the different targeting
requirements for NTNCWSs.
  The term  "state" is used throughout
the guidance document to refer  to the
primacy authority.

Monitoring Protocols

Lead and Copper
Tap Water Samples
  The tap water monitoring protocol for
lead and copper is designed to identify
the contributions of different sources of
lead and copper corrosion by-products to
drinking water. These sources include:
lead service lines, lead and  copper
interior piping, lead solder, and fixtures
and faucets. Tap water monitoring for
lead and copper allows a water system
to determine the lead and copper concen-
trations in drinking water to which its
customers may be exposed, as well as
the effectiveness of corrosion  control
treatment for reducing concentrations of
those contaminants in water. Tap water
samples for lead and copper are collected
biannually. A small PWS that installs
 and properly operates optimal corrosion
 control treatment can collect lead and
 copper tap water samples annually and
 ultimately triennially.

 Water Quality
 Parameter Samples
  A small PWS that exceeds the lead or
 copper action level during any monitor-
 ing period must collect WQP samples
 during the same  monitoring period  in
 which  it exceeds  an action level.  The
 WQP monitoring protocol is designed to
 assist each system develop optimal cor-
 rosion control treatment and help them
 determine whether treatment is properly
 operated  and  maintained over time.
 Water quality parameter samples must
 be collected at each entry point to the
 distribution system (WQP-POE) and  at
 sites in the distribution system (WQP-
 DIS) that are  representative of water
 quality  throughout the  distribution
 system.
  Initially, a small PWS that exceeds an
 action level must collect samples for pH,
 alkalinity, calcium, conductivity, water
temperature, and, if a corrosion inhibitor
is being used, orthophosphate or silica,
depending upon the inhibitor  in use.
These WQP samples must be collected
biannually at each entry  point to the
distribution  system  and   at
representative  sites throughout  the
distribution system.
  After   optimal   corrosion   control
treatment has been installed, the WQP
samples a PWS must  collect depends
upon the  corrosion  control  treatment
installed. A PWS  may have  to collect
samples for pH, alkalinity (if adjusted),
calcium   (if   calcium   carbonate
stabilization is used) and an inhibitor

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Page 2 — Monitoring Guidance for Public Water Systems
residual (if inhibitors are used). Samples
collected after treatment is installed are
used  to  monitor the  effectiveness of
treatment and  determine whether the
PWS is operating in compliance with the
rule. After treatment has been installed
WQP  samples  must  be  collected
biweekly at  each entry point  to the
distribution system and  biannually at
representative sites in the distribution
system.  Once   a  system   reduces
monitoring, WQP samples are collected
biannually,  annually,  and ultimately
triennially, at representative sites in the
distribution system.  A PWS  may not
reduce the  frequency with  which it
collects WQP samples at entry points to
the distribution system.

Lead and Copper
Source Water Samples
  Source water monitoring for lead and
copper is only required if a PWS exceeds
the lead or copper action level in tap
water samples. The purpose of requiring
lead and copper sampling at the entry
points to the distribution system is to:
(1)  determine  the  contribution  from
source water to total tap water lead and
copper levels;  (2) assist systems  in
designing an overall treatment plan for
reducing lead and copper levels at the
tap; and (3) assist the state in determin-
ing whether source water treatment is
necessary to minimize  lead and copper
levels at the tap. Source water samples
for  lead  and   copper are  collected
biannually.   A   small  system   that
maintains maximum permissible  lead
and/or copper levels in source water can
collect lead  and copper  source water
samples  annually,   triennially,  and
ultimately every nine years.
Additional Monitoring Data
  Any system that collects tap water or
 source water samples for lead, copper or
 any of the WQPs, in addition to the
 samples explicitly required in the rule,
 must report the results to the state by
 the end of the monitoring period during
 which the samples are collected.

Demonstrating Optimal
 Control Treatment with
 Tap Water and Source
 Water Samples
  A small PWS can demonstrate optimal
corrosion control treatment has been
installed with monitoring data in one of
two ways.
  First, a small PWS that meets  the
lead  and  copper  action  levels   has
installed  optimal  corrosion  control
treatment.
  Second, a  small  PWS  that  demon-
strates the difference between the 90th
percentile tap water lead level and the
highest source water lead  level is less
than 0.005 mg/L has installed optimal
corrosion control  treatment. To make
this  demonstration  the system must
collect tap water samples for lead at the
required number  of sites, and source
water samples for lead at  each entry
point to the distribution system during
each  of  two  consecutive 6-month
monitoring periods. Once a small PWS
makes this demonstration, the state will
establish water quality parameter values
(WQP-POE  and  WQP-DIS)  for   the
system.   The PWS must  continue to
operate  in  accordance with the state-
specified WQPs to remain in compliance
with the rules.

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Page 3 — Monitoring Guidance tor Public Water Systems
            Conduct a Materials Evaluation to
       Identify Lead  and Copper Sampling Sites
The Environmental Protection Agency's  lead and  copper regulations require all
public water systems to collect tap water samples to determine lead and copper levels
to which customers may be exposed. Sampling periods are 6-months in length. For
systems serving between 501 and 3300 people the first sampling period begins July 1,
1993 and ends January 1,1994. Collect 20 tap samples.

Questions about the lead  and copper rale,  or other drinking water rules, can be
answered by the EPA Drinking Water  Hotline at 800-426-4791 or your  State
Drinking Water Program.
  When Should My Materials

  July 1, 1993
                                                 at SampHng Sites?
                                        ^s^Ss^
  If you are a community water system, lead and copper tap water samples must be
  collected from sampling locations that meet one of the following criteria:
    Tier 1. single family structures that contain lead pipes, or copper pipes with lead
          solder installed after 1982, and/or are served by lead service lines.
    Tier 2. buildings and multiple-family residences that  contain lead pipes,  or
          copper pipes with lead solder installed after 1982, and/or are served by
          lead service lines.
    Tier 3. single family structures that contain copper  pipes  with lead solder
          installed before 1983.

  If you are a non-transient non-community water system,  lead and copper tap  water
  samples must be collected from sampling locations that meet one of the following
  criteria:
    Tier 1. buildings that contain copper pipes with lead solder installed after 1982,
          and/or are served by lead service  lines.
    Tier 2. buildings that contain  copper pipes  with lead  solder installed before
          1983.

  If you have a community or non-transient non-community water system and  it
  contains lead service lines, at least 50% of your sites should be served by a lead
  service line (see page 5).

  If you have no lead service lines, but you have lead goosenecks or pigtails, collect
  tap water samples  at the sites with the goosenecks and/or pigtails.

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Page 4 — Monitoring Guidance for Public Water Systems
            Conduct  a Materials Evaluation  to
       Identify Lead and Copper  Sampling Sites
   What Sources of Information Should t Review to Identify
   High Risk Materials?

 To identify enough sites that meet the targeting criteria you should survey all
 records  documenting the  materials  used  to construct and repair your
 distribution system, and buildings connected to your distribution system.

   •  Plumbing Codes
   •  Plumbing Permits
   •  Distribution Maps and Drawings
   •  Inspection and Maintenance Records
   •  Meter Installation Records
   •  Capital Improvement and Master Plans
   •  Standard Operating Procedures
   •  Operation and Maintenance Manuals
   •  Permit Files
   •  Existing Water Quality Data
   •  Interviews with Senior Personnel, Building Inspectors, and Retirees
   •  Community Survey

 It Is recommended that you identify more sampling sites than the number of
 samples you are required to collect during each monitoring period in case
 volunteers drop out
   *  For example, since you are required to collect 20 tap water samples during
      each 6-month monitoring period you probably want to maintain a list of
      about 40 sampling sites that meet the Tier 1 targeting criteria. If you cannot
      identify 40 sites  meeting the  Tier 1 targeting criteria, then you  should
      complete your list with sites meeting the  Tier 2 or Tier 3 criteria.

   •  // your system contains lead service lines, then 10 of your sites must be
      served by a lead service line. You probably want to maintain a list of about
      20 sampling sites served by lead service lines to insure access to enough
      sites.

 Several worksheets for organizing the information collected  during the  materials
 evaluation are included in your package. These worksheets should be useful when
 you determine the sites that contain the highest priority materials. You do not have
 to send them to the state, unless requested. You may want to conduct some site
 surveys to be sure you have identified sites with lead.

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Page 5 — Monitoring Guidance for Public Water Systems
            Conduct a  Materials Evaluation to
       Identify Lead and  Copper Sampling Sites
   What Should I Do if I Cannot Find Enough Sampling Sites
   with High Risk Materials?

 PLUMBING MATERIALS
 • When a sufficient number of Tier 1 sites do not exist or are inaccessible you must
   complete your sampling pool with Tier 2 sites.
 • When a sufficient number of Tier 1 and 2 sites do not exist or are inaccessible,
   you must complete your sampling pool with Tier 3 sites.
 • If you plan on collecting tap  water samples from Tier 2  or  3 sites you must
   explain why you could not identify a sufficient  number of Tier 1 sites, and notify
   the state by July 1, 1993. You will need  supporting documentation (see Form
   141-A on page 27).
 • You are not required to target buildings with lead solder installed after  the
   effective date the lead ban was adopted in your state. All states were required to
   ban the use of lead solder in all public water systems and all homes and buildings
   connected to such systems by June 1988 (most  states adopted the ban in 1987 or
   1988). Contact the Drinking Water Program in your state to  find out the effective
   date.

 LEAD SERVICE  LINES
 • When a sufficient number of lead service line sites do not exist or are inaccessible
   you must collect a tap water sample from each site served by a lead service line.
      For example, the rule requires that you collect tap water samples from 10
      sites served by a lead service line. If, after  reviewing all of the records
      listed above, you can identify only 6 sites served by a lead service line, you
      must collect a tap water sample from each of those sites.
 • If you collect tap water samples from less  than  10 sites served  by a lead service
   line, you must explain why you could not identify a sufficient number of lead
   service line sites, and notify the state by July 1, 1993 (see Form 141-A on
   page 27).
 Exceptions

 • If your system contains only plastic plumbing, but the faucets and fittings contain
   lead, you should collect tap samples at single family structures with such faucets
   and fittings (kitchen or bathroom tap).
 • If all of your available sampling sites have water softeners, you should identify
   the highest risk sites (Tier 1) and monitor at those locations (kitchen or bathroom
   tap).

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Page 6 — Monitoring Guidance for Public Water Systems
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  Page 8 — Monitoring Guidance tor Public Water Systems
WORKSHEET #3
               SUMMARY OF MATERIALS SURVEY RESULTS
 PWS ID NUMBER
 POPULATION SERVED BY PWS
PlumWng Material
Interior Plumbing
Lead Pipe
Copper Pipe With Lead Solder >1982
Copper Pipe With Lead Solder <1983
Service Lines
LSLs
Entire Line
Partial Line
Total Available Sites
'•• • .. = y-&v^ • ; • • ' Tjflpf of StfifclMf ^ ::::;:f:<;:; ,-}.'; . .
.,--.:.•- sm . ; . , if •/:,<. WH .-. ^$r; •. • BUMS ,-.. ..- .
Number of Swvloe Connecttorts




























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Page 9 — Monitoring Guidance for Public Water Systems
            How and When You  Should  Collect
          Lead and Copper Tap Water Samples
 When Do I Collect Lead and Copper Tap Water Samples?

 • Lead and copper tap water samples must be collected every 6-months. The first
   monitoring period begins on July 1, 1993 and ends on January  1, 1994.

 • You must submit  the  results of all tap water samples collected during each
   monitoring period to the  State.  All  of these  samples  collected during each
   monitoring period must always be used to calculate the 90th percentile lead and
   copper levels.
 How Do I Collect Lead and Copper Tap Water Samples?

 • Always collect a one-liter sample in one container only.

 • Always collect the first draw.

 • Always allow the water to stand at least 6-hours (i.e., no flushing, showering,
   etc.).

 • First draw samples collected at single-family residences should always  be drawn
   from the cold-water kitchen tap or the bathroom tap.

 • First draw samples  collected from buildings other than single-family residences
   should always be drawn from an interior tap from which water is typically taken
   for consumption.

 • We encourage residents to collect samples. See the instruction form on page 14
   which you should distribute to residents.

 • As a general rule, you should collect your lead and copper tap water samples early
   in the monitoring period-dun ng the first 3 months—to insure you have time to
   collect water quality parameter samples during the same monitoring period (see
   page 15).

 • During all repeat sampling, when you cannot gain access to an original  sampling
   site you  should collect a  tap water sample from another  site meeting  the same
   targeting criteria as the original site. The replacement site should be located within
   reasonable proximity of the original site (see Form 141-A on page 27).

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Page 10 — Monitoring Guidance for Public Water Systems
            How  and When You  Should Collect
           Lead  and Copper Tap Water Samples
How Many
                                                                  Initial
    You must collect at least 1 tap water sample at a minimum of 20 sites every
    6 months.
    • All sites must meet Tier 1 targeting criteria,
    •  10 sites must be served by a lead service line.
    If you exceed the lead or copper  action  level  you must complete the treatment
    technique requirements (see pages  11 and 12).
    If you meet the lead and copper action levels you may reduce samples (see Box 1
    on page 11).
                                    Control Treatment
                                    •-•rvZ'.vrsv. ". / .• .-.-. v/.\\s:'vTT'^^^vK^'liv.vvTv^'.v.-.'l'.VA*:-.::
   i You must collect 1 tap water sample at a minimum of 20 sites during each of
    2 consecutive 6-month monitoring periods.
    • All sites must meet Tier 1 targeting criteria.
    •  10 sites must be served by a lead service line.
   i If you  meet both action levels during each of 2 consecutive 6-month monitoring
    periods you can reduce monitoring to 1 tap water sample at a minimum of 10 sites
    annually.
    If you  exceed an action level in any 6-month monitoring period after installing
    optimal corrosion control treatment, you should continue to collect WQP samples.
    The state will set water quality parameter values (see page 19).
 How
 State
   You must collect 1 tap water sample at a minimum of 20 sites every 6 months.
   •  All sites must meet Tier 1 targeting criteria.
   •  10 sites must be served by a lead service line.

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Page 11 — Monitoring Guidance for Public Water Systems
            How and  When You Should Collect
          Lead and Copper Tap Water Samples
 How Many Tap Water Samples Should I Collect When
 X Reduce
  • Any time you meet both action levels during 2 consecutive 6-month monitoring
   periods you  may reduce monitoring and collect 1  sample at a minimum of
   10 sites annually.
  • Any time you exceed an action level, but operate in accordance with water quality
   parameters during 2 consecutive 6-month monitoring periods, you may request the
   state to reduce the number of lead and copper samples from 20 to 10, and reduce
   the frequency for collection from biannual to annual.
  • Any time you meet both action levels for 3 consecutive years you may reduce
   monitoring and collect 1 sample  at a minimum of 10 sites every 3 years.
  • Any time you exceed an action level, but operate in accordance with water quality
   parameters during 6 consecutive 6-month monitoring periods, you may request the
   state to reduce the frequency  for collecting 10 lead and copper samples from
   annual to triennial.
  • All tap samples collected during  reduced monitoring must be collected between
   June and September.
 How Do I Calculate 90tfr Pefcentile
   When 20 samples are collected, the 3rd highest sample value recorded during a
   6-month monitoring period is the 90th percentile.
   If the 3rd highest lead level exceeds 15 ppb you must:
   • Collect water quality parameter samples (during the 6-month monitoring
     period when the exceedance occurred).
   • Deliver  the public education program described in U.S. EPA's Public
     Education Primer (within 60 days of the exceedance).
   * Collect lead source water samples and submit a source water treatment
     recommendation  to the state, if you have not already done so  (within
     6 months of the exceedance).
   • Submit an optimal corrosion control treatment recommendation to the state,
     if you have not already done so (within 6 months of exceedance).
   If the 3rd highest copper level exceeds 1.3 ppm you must:
   • Collect water quality parameter samples (during the 6-month monitoring
     period when the exceedance occurred).
   • Collect copper source water samples and submit a source water treatment
     recommendation  to the state, if you have not already done so  (within
     6 months of the exceedance).
   • Submit an optimal corrosion  control treatment recommendation to the state,
     if you have not already done so (within 6 months of the exceedance).

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Page 12 — Monitoring Guidance for Public Water Systems
            How and When You  Should Collect
           Lead and Copper Tap Water Samples
 How Do I Calculate 9Oth Percentile Lead and Copper Levels
 During Reduced Monitoring?

 • When  10 samples are collected, the 2nd highest sample value recorded during a
   reduced monitoring period is the 90th percentile.

 • If the 2nd highest lead level exceeds 15 ppb you must:
   • Stop monitoring at a reduced number  and frequency,  and recommence
     collecting 20 tap water samples every 6 months, immediately.
   • // you  have  not installed optimal corrosion control treatment, start
     collecting 2 WQP samples every 6 months at 2 sites in the distribution
     system and at each entry point. Submit a treatment recommendation to the
     state within 6 months of exceedance.
   • If you  have  installed optimal corrosion control treatment, recommence
     collecting 2 WQP samples every 6 months at 2 sites in the distribution system,
     and 1 WQP sample at each entry point every 2 weeks, immediately.
   • // you  have  installed optimal  corrosion control  treatment,  start  or
     recommence replacing lead service lines (7% ofyourLSLs must be replaced
     within 12 months of the exceedance, and an additional 7% every 12 months
     thereafter).
   • If you have not collected lead source water samples and submitted a source
     water treatment recommendation  to the state, do so within 6 months of the
     exceedance.
   • Recommence  delivering the public  education program within 60 days of
     exceedance.

 • If the 2nd  highest copper level exceeds 1.3 ppm you must:
   • Stop monitoring at a reduced number and frequency, and recommence
     collecting 20  tap water samples every 6 months, immediately.
   * // you  have  not installed optimal corrosion control  treatment,  start
     collecting 2 WQP samples every 6 months at 2 sites in the  distribution
     system and at each entry point. Submit a treatment recommendation to the
     state within 6 months of exceedance.
   • If you have  installed optimal corrosion  control treatment,  recommence
     collecting 2 WQP samples every 6 months at 2 sites in the distribution system,
     and 1 WQP sample at each entry point every 2  weeks, immediately.
   • If you have not collected copper source water samples  and submitted a
     source water treatment recommendation to the state, do so within 6 months
     of the exceedance.

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Page 13 — Monitoring Guidance tor Public Water Systems
v Calculating the 90th Pcrcentile During
||bitial, Follow-up and Routine Monitoring
Sample Number
1
2
3
4
5
6
7
8
9
10
Sample Value
0
0
0
0
0
0
0
0
0
0
Sample Number
11
12
13
14
15
16
17
18 (90th %)
19
20
Sample Value
1
1
2
5
8
8
10
12
12
18
Calculating the 90th Percent*
Sample Number Sample Value
1 0
2 0
3 0
4 0
5 0
le During Reduced Monitoring
Sample Number Sample Value
6 1
7 5
8 6
9 (90th %) 8
10 10

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   Page 14 — Monitoring Guidance for Public Water Systems


                            Suggested Directions for

          Homeowner Tap Sample Collection Procedures


   These samples are being collected to determine the lead and copper levels in your tap water. This
sampling effort is required by the U.S. Environmental Protection Agency and your state, and is being
accomplished through the cooperation of homeowners and residents.

   A sample is to be collected after water has been sitting in the pipes for an extended period of time
(i.e., no water use during this period). Due to this requirement, either early mornings or evenings upon
returning from work are the best times  for collecting samples. The collection procedure is described
in more detail below.

   1.  Prior arrangements will be made with the customer to coordinate the sample collection event Dates will be
       set for sample kit delivery and pick-up by water department staff,

   2.  A minimum 6-hour period during which there is no water use throughout die house must be achieved prior
       to sampling. The water department recommends that either early mornings or evenings upon returning home
       are the best sampling times to ensure that the necessary stagnant water conditions exist

   3.  A kitchen or bathroom cold-water faucet is to be used for sampling. Place the sample bottle (open) below the
       faucet and gently open the cold water tap. Fill the sample bottle to the line marked "1000-mL" and turn off
       the water.

   4.  Tightly cap the sample bottle and place in the sample kit provided. Please review the sample kit label at mis
       time to ensure that all information contained on the label is correct

   5.  IF ANY PLUMBING REPAIRS OR REPLACEMENT HAS BEEN DONE IN THE HOME SINCE THE
       PREVIOUS SAMPLING EVENT, NOTE THIS INFORMATION ON THE LABEL AS PROVIDED.

   6.  Place the sample kit outside of the residence in the location of the kit's delivery so that department staff may
       pick up the sample kit

   7.  Results from this monitoring effort will  be provided to participating customers when reports are generated for
       the Stale unless excessive lead and/or copper levels are found. In those cases, immediate notification will be
       provided (usually 10 working days from the time of sample collection}.


Call	at	if you have any questions regarding these
instructions.
    TO BE COMPLETED BY RESIDENT

    Water was last used:              Time	  Date

    Sample was collected:             Time	  Date_
        I have read the above directions and have taken a tap sample in accordance with these
    directions.


    	  Date	
        Signature

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Page 15 — Monitoring Guidance for Public Water Systems
            How and When You Should Collect
             Water  Quality Parameter Samples
 Exceeding an Action Level Triggers Water Quality Parameter
 Sampling

 • If you exceed the lead or copper action level you must collect water quality
    parameter (WQP) samples from each entry point to the distribution system and
    from a set of representative sites located throughout the distribution system.
 • Because  the results of all WQP samples must be submitted to the state in the
    same  monitoring period in which you  exceeded an  action level, you should
    collect lead and copper tap water samples early in the monitoring period.
       For example, if you exceed an action level in the first monitoring period
       (from July 1, 1993 to January 1, 1994) you must collect WQP samples and
       submit the results to the state by January 1, 1994.
 How Do I Select Representative Sam
 Quality Para

 •  You must identify 2 sampling sites in your distribution system representative of
    the water quality throughout the distribution system. For ease, you may want to
    use sites used to sample for coliforms.
 •  When you identify representative sampling sites in the distribution system you
    should consider the following:
    •  size of the population you serve and where the population is located.
    •  different sources of water you currently use.
    •  different treatments installed and operating.
    •  effect of seasonal variability on treatment and water quality.
    •  proximity of WQP sites to lead and copper tap water sampling sites.
    •  proximity of WQP sites to supplemental chlorination feed points.
    •  proximity of WQP sites to ground or elevated storage locations.
    •  WQP sites' representativeness of typical detention times of water in the
       distribution system.
    •  WQP sites'  representativeness  of  distinct  pressure  zones located
       throughout the distribution system.
    •  WQP sites1 representativeness of distribution system materials.
 •  Avoid  areas  in the  distribution system where  maintenance or  flushing  is
    conducted because water quality upsets are more likely to occur in these places.
    Remember, you are trying to collect data that is representative of typical  water
    quality conditions  in the distribution system.

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Page 16 — Monitoring Guidance for Public Water Systems
            How and When You Should  Collect
             Water  Quality Parameter Samples
  How Do I Collect Water Quality Parameter Samples?

  •  Samples should be fully flushed.

  •  Samples collected at entry points to the distribution system must be collected at
     locations representative of each source of water after treatment.

  •  If your system draws water from more than one source, and  the sources are
     combined before distribution, you must collect samples at sites in the distribution
     system where the water is representative  of all sources being used.

  •  If you collect the WQP samples in the distribution system from the same location
     as coliform and disinfectant  residual samples you  should collect  the WQP
     samples in  the following manner
     •  Fully flush  the tap and collect the coliform sample.
     •  Collect  a sample to measure disinfectant residual,
     •  Collect  and analyze sample for temperature and pH.
     •  Collect  the  samples for the other WQPs.

  •  If fire hydrants or other types of distribution system fixtures are in the vicinity of
     a sampling site, fully flush the sample before collecting.

  •  When you  collect  WQP samples  you should always record your observations
     about color, suspended solids, and the flushing time required prior to achieving
     acceptable sampling conditions.

  •  When  you collect  WQP   samples  for  alkalinity,  calcium,  conductivity,
     orthophosphate, and silica you should take two 500-mI samples.

  •  Temperature analyses must be conducted in the field to insure accuracy. Measure
     temperature using either a hand-held thermometer or a combined  temperature/pH
     electrode and meter.

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Page 17 — Monitoring Guidance for Public Water Systems
            How and When You Should Collect
             Water Quality  Parameter Samples
 How Bo I Collect Water Quality Parameter Samples?

 • pH measurements must also be conducted in the field and must be made with a
    pH electrode and meter within 15 minutes of sample collection. The meter should
    be capable of measuring to 1/10 of a unit.

 • The pH probe should be placed in a sample bottle and secured during transport.
    The probe's membranes are very  delicate and should not come in contact with
    hard surfaces or be allowed to dry out. Pack a replacement probe just in case.
    •  Before collecting the pH sample, the pH electrode should be calibrated
       at pH 7.0 and a second pH level; either 4.0 or 10.0, depending on the
       pH range typically found within the distribution system.
    *  When collecting WQP samples, care should be taken to avoid agitating
       the water sample (i.e., shaking, bouncing in transit, etc.).
    •  Before collecting the sample, remove the faucet aerator and run the
       water gently to flush the line.
    •  Fill the sample bottle to slightly overflowing.
    •  Use a closed-system bottle—which allows you to insert the thermometer
       or pH probe—to reduce measurement error.
    •  If you use a hand-held thermometer, insert it in the sample and record
       the reading when it stabilizes. Insert the pH electrode immediately after
       removing the thermometer.
    •  If you  use  a combined electrode and meter, insert it in the sample
       immediately after filling the bottle and measure temperature. Change the
       meter to  measure pH levels and gently rotate the bottle  until the pH
       reading stabilizes (may take several minutes).
    •  Record the pH measurement, rinse the electrode with deionized water
       and replace it in the holding bottle.
 • Plastic or  glass containers can be  used when collecting WQP samples except if
    silica analyses are required (plastic must be used).

 • WQP samples should be stored separately  from coliform samples to prevent
    contamination. All samples  should be  stored  in  a cool  environment  until
    analyzed.

 • You may  take a confirmation sample for any WQP sample  within  3 days of
    receiving the results of the first sample. If you collect a confirmation sample, you
    must average the two results to determine compliance.

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Page 18 — Monitoring Guidance for Public Water Systems
            How and When You Should Collect
            Water Quality Parameter Samples
 How Many Water Quality Parameter Samples Should I Coflect
 In the Monitoring Period In Which an Action Level I» Initially
 Exceeded?

 • Collect WQP samples at representative sites in the distribution system and at
    each entry point to the distribution system for:
    •  pH
    *  Alkalinity
    •  Calcium
    •  Conductivity
    *  Temperature
    •  Orthophosphate, when a phosphate-based inhibitor is used
    •  Silica, when a silicate-based inhibitor is used

 • Collect 2 samples at each of 2 sites located throughout your distribution system
    during the first 6-month monitoring period in which you exceed an action level.

 • Collect 2 samples at each entry-point to your distribution system during the
    first 6-month monitoring period in which you exceed an action level.

 • Within 6 months of exceeding an action level you must submit an  optimal
    corrosion control treatment recommendation to the state (see § 141.82 or the
    corrosion control treatment guidance for details).

 • The 2 WQP samples should be collected at different times in the monitoring
    period to insure you have water quality data that is representative of seasonal
    changes that can take place during a monitoring period.

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Page 19 — Monitoring Guidance tor Public Water Systems
            How and When You Should Collect
            Water Quality Parameter Samples
 How Many Water Quality Parameter Samples Should I Collect
 Alter Installing Optimal Corrosion Control Treatment?

 • If you continue to exceed an action level after installing optimal corrosion
    control treatment you must collect WQP samples during the 12 month period
    immediately  after you have completed installing treatment.

 • 2 samples must be collected at each of 2 sites in your distribution system
    during each of 2 consecutive 6-month monitoring periods for:
    •  pH
    •  Alkalinity
    •  Calcium,  when calcium carbonate stabilization is used
    •  Orthophosphate, when a phosphate-based inhibitor is used
    *  Silica, when a silicate-based inhibitor is used

 • 1 sample must be collected at each entry point to your distribution system
    every 2 weeks for
    •  pH
    •  When alkalinity is adjusted,  the concentration of alkalinity
    •  When an inhibitor is used, the  concentration of orthopnosphate or
       silicate (whichever is used)

 • On the basis  of WQP samples collected during this 12-month period the state
    will establish WQP values you must meet in all subsequent monitoring periods
    to remain in compliance  with the regulation.
       For example, the  state might require you to maintain pH between 7.8
       and 8.2 at each entry point and a pH of 7.0 to 8.0 at all sampling sites
       in the distribution system.  Similarly, the state might require you to
       install sodium bicarbonate at a dosage rate of 10 mgIL (measured at
       each entry-point) to  maintain alkalinity  above 20 (measured at all
       distribution system sites).

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Page 20 — Monitoring Guidance tor Public Water Systems
            How and When You Should Collect
            Water Quality Parameter Samples
 How Many Water Quality Parameter Samples Should X Collect
 After the State Sets Water guality Parameter Vainest

 • 2 samples must be collected at each of 2 sampling sites in your distribution
    system every 6 months for:
    •  pH
    •  Alkalinity
    •  Calcium, when calcium carbonate stabilization is used
    •  Orthophosphate, when a phosphate-based inhibitor is used
    •  Silica, when a silicate-based inhibitor is used

 • 1 sample must be  collected at each entry point to your distribution system
    every 2 weeks for
       When alkalinity is adjusted, the concentration of alkalinity
       When an inhibitor is used, the concentration of orthophosphate or
       silicate (whichever is used)
 How Many Water Quality Parameter Samples Should 1 Collect
 During Reduced Monitoring?

 • If you maintain the state-specified values for WQPs at representative sites in
    the distribution system for 8 consecutive 6-month monitoring periods, you may
    reduce the frequency with which you collect 2 WQP samples at 2 sites in the
    distribution system from biannually to annually.

 • If you maintain the  state-specified values for WQPs at 2 sites in your
    distribution system for 3 consecutive years you  may reduce the frequency with
    which you collect 2 WQP samples at 2 sites in the distribution system from
    annually to every 3 years.

 • WQP samples must always be collected at each entry point to the distribution
    system every 2 weeks.

 • WQP sampling may be discontinued any time  you meet the lead and copper
    action levels.

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Page 21 — Monitoring Guidance for Public Watsr Systems
            How and When You Should Collect
        Lead and Copper Source Water Samples
 Exceeding an Action Level Triggers Source Water Monitoring

 • If you exceed the lead and/or copper action level you must collect one lead
    and/or copper source water sample from each entry point to the distribution
    system and submit the results to the state within 6 months of exceeding an action
    level.

 • A water system can stop collecting lead and/or copper samples if the  system
    meets the lead and copper action levels during the entire source water sampling
    period applicable to the system (i.e., 1 year or 3 years).
 Where Do I Collect Lead and

 If You Are a Ground Water System

 •  Collect at least one sample at each entry point to the distribution system that
    is representative of each well.

 •  If there are separate entrances to your distribution system from either individual
    wells or wellfields, a sample must be collected from each discrete entrance
    point.

 •  If you use multiple wells that draw from the same aquifer, the state can identify
    an individual well for monitoring, as long as there is no treatment or blending.

 •  You must take each repeat sample at the same sampling site unless conditions
    make sampling at another site more representative of each source or treatment
    plant.

 If You Are a Surface Water System (or Combination Ground Water/Surface
 Water System)

 •  Collect at least one sample at each entry point to the distribution system which
    is representative of each source of water. These samples may be collected after
    storage or at the high service pumps.

 •  You must take each repeat sample at the same sampling site unless conditions
    make sampling at another site more representative of each source or treatment
    plant.

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Page 22 — Monitoring Guidance tor Public Water Systems
            How and When You Should Collect
        Lead and Copper Source Water Samples
 How Many Lead ana Copper Source Water Samples Sfeotzld I
 *i*atf*j>* V\m**^* 9it*&*lFliiJto*«^*iM*i*a^
    If you exceed the lead or copper action level you must collect 1 sample at each
    entry  point to the distribution system and  analyze  it for  the appropriate
    contaminant. You must submit the results of  all source water samples to the
    state within 6 months of exceeding the lead or copper action  level.
       For example, if you exceed an action level in the first monitoring period
       (from July 1, 1993  to January 1, 1994) you must collect source water
       samples and submit the results to the state by July 2, 1994.

    In addition to submitting source water samples, you must also  submit a source
    water  treatment recommendation (which may include a recommendation that
    no source water treatment is needed) to the state for review and approval (see
    40 CFR § 141.83 for details).
 HowM
 Collect
Lea
    If you are required to install source water treatment, you must collect 1 sample
    at each entry point to the distribution system during each of 2 consecutive
    6-month monitoring periods.

    The state will set maximum permissible levels (MPL) for source water lead
    and/or copper concentrations based on these results. See schedule on page 26.

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Page 23 — Monitoring Guidance for Public Water Systems
           How and When You Should Collect
       Lead and Copper Source Water Samples
How Many Lead and Copper Source Water Sam
Collect Alter the State Sets Maximum Permiss
                                                    ples Sbotald I
                                                    ible Levels?
 If You Are a Groundwater System
 •  You must collect 1 sample at each entry  point to the distribution system
    beginning in the 3-year compliance period in effect when the state specifies a
    maximum permissible level(s). See the schedule on page 26 for the compliance
    period in which you should begin monitoring.

 •  You must continue to collect 1 sample at each entry point to the distribution
    system during each subsequent 3-year compliance period.

 If You Are a Surface Water System (or Combination Ground Water/Surface
 Water System)

 •  You must collect 1 sample at each entry  point to the distribution system
    annually, beginning on the date the state specifies a maximum permissible
    level(s). See the schedule on page 26 for the year in which you should begin
    monitoring.
 How Many
                      u
                            tonftor
 If You Are a Groundwater System
 • If you meet the maximum permissible level(s) set by the state for 3 consecutive
   3-year compliance periods you can reduce source water monitoring to once
   every 9-year compliance cycle.

 If You Are a Surface Water System (or Combination Ground Water/Surface
 Water System)
 • If you meet the maximum permissible level(s) set by the state for 3 consecutive
   years you can reduce source water monitoring to once every 9-year compliance
   cycle.

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   Page 27 — Monitoring Guidance for Public Water Systems

Form 141-A
Page 1 of 3
               SAMPLE SITE IDENTIFICATION AND CERTIFICATION
System's Name:
Address:
Tvoe: D CWS D N7NCWS
Size: O > 100,000
a 10.001 to 100.000
D 3.301 to 10.000
D 501 to 3.300
Telephone number:
Svstem ID #:
Contact Person:
a 101 to soo
D s100



                         CERTIFICATION OF SAMPLING SITES
LEAD SOLDER SITES
# of single-family structures with copper pipes with lead solder installed
   after 1982 or lead pipes and/or lead service lines {Tier 1)
# of multi-family structures with copper pipes with lead solder installed
   after 1982 or lead pipes and/or lead service lines (Tier 1)
# of buildings containing copper pipes with lead solder installed
   after 1982 or lead pipes and/or lead service lines (Tier 2)
# of sites that contain copper pipes with lead solder installed before 1983
   (to be used only if other conditions have been exhausted) (Tier 3)

                                                       TOTAL
The following sources have been explored to determine the number of structures which have
interior lead pipe or copper pipe with lead solder.

	       Plumbing and/or building codes
	       Plumbing and/or building permits
	       Contacts within the building department, municipal clerk's office, or state regulatory
              agencies for historical documentation of the service area development
	       Water Quality Data
   Other Resources Which PWS May Utilize

	       Interviews with building inspectors
	       Survey of service area plumbers about when and where lead solder was used from 1982 to
              present
	       Survey residents in sections of the service area where lead pipe and/or copper pipe with
              lead solder is suspected to exist
	       Interviews with local contractors and developers

Explanation of Tier 2 and Tier 3 sites (attach additional pages if necessary)

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   Page 28 — Monitoring Guidance for Public Water Systems

Form 141-A (continued)
Page 2 of 3
                SAMPLE SITE IDENTIFICATION AND CERTIFICATION
                          CERTIFICATION OF SAMPLING SITES
 LEAD SERVICE LINE SITES
 # of samples required to be drawn from lead service line sites
 # of samples actually drawn from lead service line sites
 Difference (explain differences other than zero)
 The following source* have been explored to determine the number of lead service lines In the
 distribution system.
 	       Distribution system maps and record drawings
 	       Information collected for the presence of lead and copper as required under §141.42 of the
               Code of Federal Regulations
 	       Capital improvement plans and/or master plans for distribution system development
 	       Current and historical standard operating procedures and/or operation and maintenance
               (O&M) manuals for the type of materials used for service connections
 	       Utility records including meter installation records, customer complaint investigations and all
               historical documentation which indicate and/or confirm  the location of lead service
               connections
 	       Existing water quality data for indications of 'troubled areas'
    Other Sources Which PWS Utilized
 	       Interviews with senior personnel
 	       Conduct service line sampling where lead service lines are suspected to exist but their
               presence is not confirmed
 	       Review of permit files
 	       Community survey
 	       Review of USGS maps and records
 	       Interviews with pipe suppliers, contractors, and/or developers

 Explanation of fewer than 50% LSL sites identified (attach additional pages if necessary):
 I certify that:
    Each first draw tap sample for lead and copper is one liter in volume and has stood motionless in the
 plumbing system of each sampling site for at least six hours.
    Each first draw sample collected from a single-family residence has been collected from the cold water
 kitchen tap or bathroom sink tap.
    Each first draw sample collected from a non-residential building has been collected at an interior tap
 from which water is typically drawn for consumption.
    Each first-draw sample collected during an annual or triennial monitoring period has been collected in
 the months of June, July, August or September.
    Each resident who volunteered to collect tap water samples from his or her home has been properly
 instructed by [insert water system's name]
 in the proper methods for collecting lead and copper samples. I do not challenge the accuracy of those
 sampling results. Enclosed is a copy of the material distributed to residents explaining the proper collection
 methods, and a list of the residents who performed sampling.

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  Page 29 — Monitoring Guidance for Public Water Systems

Form 141-A (continued)
                                            Page 3 of 3
             SAMPLE SITE IDENTIFICATION AND CERTIFICATION
                          RESULTS OF MONITORING
 THE RESULTS OF LEAD AND COPPER TAP WATER SAMPLES MUST BE ATTACHED TO THIS
 DOCUMENT
 # of samples required
# of samples submitted
90th Percentile Pb
90th Percentile Cu
 THE RESULTS OF WATER QUALITY PARAMETER SAMPLES MUST BE ATTACHED TO THIS
 DOCUMENT
 # of samples required          	   # of tap samples submitted      	
 # of entry point samples required	   # of entry point samples submitted	
                        CHANGE OF SAMPLING SITES
Original site address:
New site address:
Distance between sites (approximately):
Targeting Criteria: NEW:
         OLD:
Reason for change (attach additional pages if necessary):
SIGNATURE
 NAME
        TITLE
       DATE

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  Page 30 — Monitoring Guidance for Public Water Systems


Form 141-B
                                       Page 1 of 1
  REQUEST FOR REDUCED LEAD AND COPPER TAP WATER MONITORING
System's Name:
Address:
Tvoe: n CWS D NTNCWS
Size: n > 100,000
D 10.001 to 100.000
O 3.301 to 10.000
D 501 to 3.300
Telephone number:
System ID #:
Contact Person:
a 101 to 500
a *ioo



                            REQUEST FOR REDUCTION
   The
                     water system has:
   D maintained tap water levels below the lead/copper action levef(s); or

   O operated in accordance with the state-specified water quality parameters during
       each of the following six-month monitoring periods:
   The above named water system hereby requests that the state permit the system to reduce lead and
   copper tap water monitoring from:
           n Biannual to Annual

           D Annual to Triennial
            D  1001050
            D  60 to 30
            D  40to20
            D  20 to 10
            n  10 to 5
   The results of all water quality parameter samples and lead and copper tap water
   samples collected during each of the monitoring periods are summarized and attached.
 SIGNATURE
 NAME
TITLE
DATE

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   Page 31 — Monitoring Guidance for Public Water Systems

 Form 141-C
                                 Page 1 of 2
   OPTIMAL CORROSION CONTROL TREATMENT/WATER QUALITY PARAMETER
System's Name:
Address:
Type: Q CWS O NTNCWS
Size: D >100,000
D 10.001 to 100.000
D 3.301 to 10.000
O 501 to 3.300
Telephone number:
Svstem ID *
Contact Person:
O 101 to 500
a sioo



THE RESULTS OF SOURCE WATER AND TAP WATER SAMPLES MUST BE ATTACHED TO THIS
DOCUMENT
# of tap water samples required
f of source water samples required
   * of tap water samples submitted

_| of source water samples submitted
RESULTS OF OPTIMAL CORROSION CONTROL TREATMENT STUDIES
TEST 1 — ALKALINITY & pH ADJUSTMENT
Before









Parameters
Pb
Cu
PH
alkalinity
calcium
conductivity
orthophosphate
silicate
water
temperature
After









TEST 3 — ADDITION OF CORROSION
INHIBITOR
Before









Parameters
Pb
Cu
PH
alkalinity
calcium
conductivity
orthophosphate
silicate
water
temperature
After









TEST 2 — CALCIUM HARDNESS
TREATMENT
Before









TEST 4 —
Before









Parameters
Pb
Cu
PH
alkalinity
calcium
conductivity
orthophosphate
silicate
water
temperature

Parameters
Pb
Cu
PH
alkalinity
calcium
conductivity
orthophosphate
silicate
water
temperature
After










After









If the state requires the system to conduct additional treatment analyses, copy this form and attach
the results as specified above.

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  Page 32 — Monitoring Guidance for Public Water Systems

Form 141-C (continued)
                                      Page 2 of 2
  OPTIMAL CORROSION CONTROL TREATMENT/WATER QUALITY PARAMETER
      OPTIMAL CORROSION CONTROL TREATMENT RECOMMENDATION
 1. Treatment recommendation and rationale:
 2. Test methodologies used to evaluate each treatment (e.g., pipe rig loop tests, metal coupon tests, etc.):
 3. Identify any chemical or physical constraint that limits or prohibits the use of a particular corrosion control
   treatment (attach all data indicating that a particular treatment has adversely affected other water
   treatment processes or is ineffective for reducing corrosion):
   Tlie
                  water system certifies that optimal
 corrosion control treatment has been installed and is being properly operated as agreed to between the
 above named water system and the state of	. Optimal corrosion control treatment
 was required to be installed by	(date). Optimal corrosion control treatment was installed on
                       .(date).
 MODIFICATION OF CURRENT CORROStON CONTROL TREATMENT AND/OR
                  """	"  "181""  " ""     "   "  '"   """""""""""
   Reason for modification:
 Attach all supporting studies, data, treatment specifications, etc. that substantiate this request for modification.
 SIGNATURE
 NAME
TITLE
DATE

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  Page 33 — Monitoring Guidance for Public Water Systems
Form 141-D
                  Page 1 of 2
            SOURCE WATER MONITORING AND TREATMENT
System's Name:
Address:
Tvoe: D CWS d NTNCWS
Size: O > 100,000
D 10.001 to 100.000
O 3.301 to 10,000
a 501 to 3.300
Telephone number:
Svstem ID #:
Contact Person:
O 101 to 500
a sioo



                       SOURCE WATER DATA
  7.
 10.
             Entry PohrtUcalton
PbValuw

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  Page 34 — Monitoring Guidance for Public Water Systems

Form 141-D (continued)                                                    Page 2 of 2
              SOURCE WATER MONITORING AND TREATMENT
SOURCE WATER
TREATMENT RECOMMENDATION
Treatment recommendation:


Reason for treatment/no treatment recommendation:


Attach additional pages as necessary.
 CERTIFICATION THAT SOURCE WATER TREATMENT HAS BEEN INSTALLED
 The
                water system certifies that source
 water treatment has been installed and is being property operated as agreed to between the above named
 water system and the State of	. Water treatment was required to be installed
 by	(date). Source water treatment was actually installed on
    MODIFICATION OF STATE TREATMENT DECISION AND/OR MAXIMUM
                 PERMISSIBLE LEAD AND COPPER LEVELS
 Reason for modification:
 Attach all supporting studies, data, treatment specifications, etc. that substantiate this request for modification.
 SIGNATURE
 NAME
TITLE
DATE

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