United States
        Environmental Protection   Office of Water     EPA 812/B-92-006
        Agency          (WH-550)        May 1992
v>EPA   LEAD AND COPPER
        MONITORING GUIDANCE for
        WATER SYSTEMS SERVING

        3,301 to 10,000 PERSONS
  ro
  CO
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                         "ION AGENCY

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        Lead and Copper
     Monitoring Guidance
                 for
    Water Systems Serving
    3,301 to 10,000 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 LKVEL (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 IB 15 ppb measured  in  the 80th
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 corroeivity 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 (LSL) 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 aolder.

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' tape 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.

SFRfl 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.
STR-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 i — Monitoring GuManct tor Public Watw 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 medium 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 medium PWS that exceeds the lead
 or copper action level during any moni-
 toring 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 medium 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, and ultimately,  annually 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  medium  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 medium  PWS  can demonstrate
 optimal corrosion control treatment has
 been installed with monitoring data in
 one of two ways.
  First, a medium PWS that meets the
 lead  and  copper action  levels  has
 installed  optimal  corrosion  control
 treatment.
  Second, a medium 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 (60), 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  medium
 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 for 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 (-months in length. For
systems serving between 3,301 and 10,000 people the first sampling period begins
July 1, 1992 and ends January 1, 1993. Collect 40 tap samples

Questions about the  lead and copper rule, or other drinking water  rules, can be
answered  by the EPA Drinking  Water Hotline at 800-476-4291 or  your State
Drinking Water Program.
  When Should My Materials Evaluation Be Completed?

  July 1, 1992
  What Type of Material Am I Looking for at Sampling Site*?

  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 I. 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 I Review to Identify
   High Risk Material*?

 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 40 tap water samples during
      each 6-month monitoring period you probably want to maintain a list of
      about 80 sampling sites that meet the Tier 1 targeting criteria. If you cannot
      identify 80 sites meeting the Tier 1  targeting criteria,  then you should
      complete your list with sites meeting the Tier 2 or Tier 3 criteria.

   •  If your system contains  lead service  lines, then 20 of your sites must be
      served by a lead service line. You probably want to maintain a list of about
      40 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 tor Public Wattr 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 Material*?

  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, 1992. You will need supporting documentation (see attached
   Form 141-A).
  • 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 20
      sites served by a lead  service line.  If, after reviewing all of the records
      listed above, you can identify only 12 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 20 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, 1992. See attached Form 141-A.
    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 7 — Monitoring Guidance tor Public Water Systems
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  Page 8 — Monitoring Guidance for 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
Type of Structure
SFR [ HPR
| BLDG
Number of Service Connecflon*




























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

  • Lead and  copper tap water samples must be collected every 6-months. The first
    monitoring period begins on July 1,  1992 and ends on January 1, 1993.

  • 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.
  Row 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 enourage 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-during 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 Tap Water Samples Should I Collect During Initial
 Monitoring?

 • You must collect 1 tap water sample at a minimum of 40 sites every 6 months.
   • All sites should meet Tier 1 targeting criteria.
   • 20 sites should 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).
 How Many Tap Water SamplesShould I Collect After
 Installing Optimal Corrosion Control Treatment?

 • You must collect 1 tap water sample at a minimum of 40 sites during each of
   2 consecutive 6-month monitoring periods.
   • All sites should meet Tier 1 targeting criteria.
   • 20 sites should be served by a lead service line.
 • 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 20 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 parmater values (see page 19).
 How Many Tap Water Samples Should I Collect After the
 State Set* Water Quality Parameters?

 • You must collect 1 tap water sample at a minimum of 40 sites every 6 months.
   • All sites should meet Tier 1 targeting criteria.
   • 20 sites should be served by a lead service line.

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Page ll — 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
 I Reduce Monitoring?

 • 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
   20 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 40 to 20, 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 20 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 20 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 90th Percentile Lead and Copper Level*
  During Initial. Follow-up and Routine Monitoring?

  • When 40 samples are collected,  the 5th highest sample value recorded during a
    6-month monitoring period is the 90th percentile.
  • If the 5th 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 5th 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 tor Public Water Systems
            How and When You Should  Collect
          Lead and Copper Tap  Water Samples
 How Do I Calculate 90th Percentile Lead and Copper Level*
 During Reduced Monitoring?

 • When 20 samples are collected, the 3rd highest sample value recorded during a
   reduced monitoring period is the 90th percentile.

 • If the 3rd highest lead level exceeds 15 ppb you must:
   * Stop monitoring at a reduced number  and frequency, and recommence
     collecting 40 tap water samples every 6  months (immediately).
   • // you  have not installed  optimal corrosion  control treatment,  start
     collecting 2 WQP samples every 6 months at 3  sites in  the distribution
     system and at each entry point. Submit a treatment recommendation to the
     state within 6 months of exceedance.
   • // you  have installed optimal corrosion control treatment,  recommence
     collecting 2 WQP samples every 6 months at 3 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% of your LSLs 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 3rd highest copper level exceeds 1.3 ppm  you  must:
   • Stop monitoring at a reduced number and frequency,  and recommence
     collecting 40 tap water samples every 6 months immediately.
   * // you  have not installed optimal corrosion control treatment,  start
     collecting 2 WQP samples every 6 months at 3 sites in the distribution
     system and at each entry point. Submit a  treatment recommendation to the
     state within 6 months of exceedance.
   • // you  have installed optimal corrosion control treatment,  recommence
     collecting 2 WQP samples every 6 months at 3 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
|^ Calculating the 9Oth Percentile During
Soltiat Follow-up and Routine Monitoring
•ymT • • " .• •:•-.
Sample Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Sample Value
0
0
0
0
0
0
o
0
0
0
0
0
0
0
0
0
0
0
0
0
Sample Number
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36 (90th %)
37
38
39
40
Sample Value
0
0
0
0
0
2
2
2
2
2
6
6
6
6
10
10
10
20
20
25
r>l<*iii4tintf til

Sample Number
1
2
3
4
5
6
7
8
9
10
e 9Otit Percentt
Sample Value
0
0
0
0
0
1
1
1
2
3
I'^h V^^M^^^A^M ^f ' l^fc^ik^B^te^kj
Vff mnXFswff KttWtC1
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Sample Number
11
12
13
14
15
16
17
18(9Oth%)
19
20
ed Monitoring
'.'.':' ' ••::• • : ...':••• • -
Sample Value
5
5
5
6
10
10
10
11
12
20

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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 the 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 this
       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 State 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
instructions.
at
if you have any questions regarding these
    TO BE COMPLETED BT RESIDENT
     Water was last used:

     Sample was collected:
    Time_

    Time
        Date_

        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, 2992 to January 1,  1993) you must collect WQP samples and submit the
     results to the state by January 1, 1993.
  How Do I Select Representative Sampling Sites lor Water
  Quality Parameters?

  •  You must identify 3 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 colifonns.
  •  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 sites' 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 Waiter 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
    •  Fulfy flush  the tap and collect the coliform sample.
    •  Collect a sample to measure disinfectant residual
    •  Collect and analyze sample far temperature and pff.
    •  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-ml 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 tor Public Water Sytttmt
            How and When You  Should Collect
             Water Quality Parameter  Samples
  How Do I Collect Water Quality Purameter 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 Guidanca tor Public Water Systems
            How and When You Should Collect
            Water Quality Parameter Samples
 How Many Water Quality Parameter Samples Should 1 Collect
 in the Monitoring Period in Which an Action Level U 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 3 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 Section 141.86 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 take place during a monitoring period.

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Page 19 — Monitoring GuManct tor Public Water Systtms
            How and When You Should Collect
             Water Quality Parameter Samples
  How Many Water Quality Parameter Samples Should I Collect
  After 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 3 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
     9  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 Orthophosphate 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 mg/L (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 I Collect
 After the State Sets Water Quality Parameter Values?

 • 2 samples must be collected at each of 3 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
    •  pH
    •  When alkalinity is adjusted, the concentration of alkalinity
    •  When an inhibitor is used, the concentration of orthophosphate or
       silicate (whichever is used)
 How Many Wata
 During Reduced
Parameter Samples Should I Collect
    If you maintain the state-specified values for WQPs at 3 sites in the distribution
    system for 8 consecutive 6-month monitoring periods (beginning on the date
    the state sets WQP values), you may reduce the frequency with which you
    collect 2 WQP samples in the distribution system from biannually to annually.

    If you maintain the state-specified values  for WQPs at 3 sites in your
    distribution system for 3 consecutive years you may reduce the frequency with
    which you collect 2 WQP samples at 3 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 Wattr Systems
            How and When  You Should Collect
        Lead and Copper Source  Water Samples
  Exceeding an Action Level Triggers Source Witter 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 in source water 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 Copper Source Water Samples?

  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.

  // 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 during normal operating conditions 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 for Public Water Systems
           How and When You Should Collect
        Lead and Copper Source Water Samples
 How Many Lead and Copper Source Water Samples Should I
 Collect During Initial Monitoring?

 • 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, 1992 to January 1, 1993) you must collect source water
       samples and submit the results to the state by July 1, 1993.

 • 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 § 141.84 for details).
 How Many Lead and Copper Source Water Samples Should I
 Collect After Installing Source Water Treatment?

 •  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 Samples Should I
 Collect After the State Seta Maximum Permissible 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 I 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 Lead and
  Collect During Redt
    Source Water Samples Should I
Monitoring?
 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-yemr compliance cycle.

 // 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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I
1
3

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   Page 27 — Monitoring Guidance for Public Water Systems

Form 141-A
                SAMPLE SITE IDENTIFICATION AND CERTIFICATION
                                                                      Page 1 of 3
System's Name:
Address:
Tvoe: D CWS D NTNCWS
Size: D >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 SOD
D s100



                         CERTIFICATION OF SAMPLING STTES
 LEAD SOLDER SITES
 # of single-family structures with copper pipes with lead sotder 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 structure* which have
 Interior lead pipe or copper pipe wttti 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
 	       Wafer Quality Data
    Other R
     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 tor Public Water Systems

Form 141-A (continued)
               SAMPLE SITE IDENTIFICATION AND CERTIFICATION
Page 2 of 3
                         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 sources 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 tines 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):
                     CERTIFICATION OF COLLECTION METHODS
 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 tor Public Water Systems

Form 141-A (continued)
             SAMPLE SITE IDENTIFICATION AND CERTIFICATION
                                            Page 3 of 3
                          RESULTS OF MONITORING
 THE RESULTS OP LEAD AND COPPER TAP WATER SAMPLES MUST BE ATTACHED TO THIS
 DOCUMENT
 f of temples required
# of samples submitted
901ft Percentlle Pb
90th Percentlle Cu
 THE RESULTS OF WATER QUALITY PARAMETER SAMPLES MUST BE ATTACHED TO THIS
 DOCUMENT
 * of templet required         	   t of tap samples submitted      	
 f of entry point samples required	
              # of entry point samples submitted
                        CHANGE OF SAMPUNG StTES
 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
Svetem'e Name:
Addreee:


Telephone number:
Svstem ID *
Tvne: O CWS n NTNCWS
Size: O > 100,000
n 10.001 to 100.000
n 3.301 to 10.000
a 501 to 3.300
a 101 to soo
n *ioo

Contact Person:

                            REQUEST FOR REDUCTION
   The
                    water system has:
   a maintained tap water levels below the iead/copper action leveJ(s); or

   D 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 toad and
   copper tap water monitoring from:
           D Biannual to Annual

           D Annual to Triennial
            n lootoso
            G 60 to 30
            D 40 to 20
            D 20 to 10
            n lotos
   The results of al water quality parameter samples and lead and copper tap water
   samples cottecfed during each of the monitoring periods are summarized and attached.
 SIGNATURE
 NAME
TRIE
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:
Tyoe: n CWS a NTNCWS
Size: a >100,000
n 10.001 to 100.000
n 3.301 to 10.000

Telephone number:
Svstem ID £
Contact Person:
O 501 to 3.300
a 101 to 500
a sioo



THE RESULTS OF SOURCE WATER AND TAP WATER SAMPLES MUST BE ATTACHED TO THIS
DOCUMENT
f of tip water eamplee required
f of source water tamplee required
   t of tap water Hmpl«e submitted

_f of source water semplea submitted
RESULTS OF OPTIMAL CORROSION CONTROL TREATMENT STUDIES
TEST 1 — ALKALINITY & pH ADJUSTMENT
Before









Parameter*
Pb
Cu
PH
alkalinity
calcium
conductivity
orthophosphata
silicate
water
temperature
After









TEST 3 — ADDITION OF CORROSION
INHIBITOR
Before









Parameter*
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):
  CERTIFICATION THAT OPTIMAL CORROSION CONTROL TREATMENT HAS
                               BEEN INSTALLED                      -
   The
                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 CORROSION CONTROL TREATMENT AND/OR
                        WATER QUAUTY PARAMETERS
   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 tor Public Water Systems
Form 141-0
             SOURCE WATER MONITORING AND TREATMENT
Page 1 of 2
System's Name:
Address:
Tvoe: O CWS n NTNCWS
Size: D >100,000
n 10.001 to 100.000
n 3.301 to 10.000
D 501 to 3.300
Telephone number:
System ID #:
Contact Person:
a 101 to 500
D *100



s^^
Al
Samj
point

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
ftarh A! riata miartarf rf aB anhv rrinfe tn tha Hfetrihrrftf"* •**+**« i I^MM kJ^*
EWMl OB UOUft VUWKUHI • M VHRIJr |MHWB VV UI9 URHIAMW
•** — L feu thin mriniimrbiri ndwlAil nnit n«(a*k **- .iniriita^ at ",
m\$mi BM nforuranng pvioa ana juoit  tny
ttOtfttf SiR^iif COJhK
PbVakiM










wst values obtafced*»
teiateacftartiy
GuVttiM











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  Page 34 — Monitoring Guidance for Public Water Systems

Form 141-0 (continued)
              SOURCE WATER MONITORING AND TREATMENT
                                  Page 2 of 2
SOURCE WATER
TREATMENT RE COMMENDATION
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 properly 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	(date).
    MODIFICATION OF STATE TREATMENT DECISION AND/OR MAXIMUM
                 PERMISSIBLE LEAD AND COPPER LEVELS
 Reason for modification:
 Attach alt supporting studtes, data, treatment specifications, etc. that substantiate this request for modification.
 SIGNATURE
 NAME
TITLE
DATE

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