United States
        Environmental Protection  Office of Water      EPA 812/B-92-004
        Agency         (WH-550)        May 1992
&EPA   LEAD AND COPPER
        MONITORING GUIDANCE for
        WATER SYSTEMS SERVING

        101 to 500 PERSONS

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        Lead and Copper
      Monitoring Guidance
                  for
     Water Systems Serving
       101 to 500 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 is 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 (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 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 l — 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 spider, 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 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 6-months in length. For
systems serving between 101 and 500 people the first sampling period begins July 1,
1993 and ends January 1, 1994. Collect 10 tap samples.

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

  July 1, 1993
  What Type of Material Am I Looking for at Sampling Sites?

  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 2982, 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 tor Public Water Systems
            Conduct a Materials  Evaluation to
       Identify Lead and Copper Sampling Sites
   What Sources of Information Should 1 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 10 tap water samples during
      each  6-month monitoring period you probably want to maintain a list of
      about 20 sampling sites that meet the Tier 1 targeting criteria. If you cannot
      identify 20 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  5 of your sites must be
      served by a lead service line. You probably want to maintain a list of about
      10 sampling sites served by lead service lines.

  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
      5 sites served by a lead service line. If, after reviewing all of the records
      listed above, you can identify only 2 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 5 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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WORKSHEET #1
                          MATERIALS SURVEY INVESTIGATION RESULTS
PV
PC
VS ID NUMBER
)PULATION SERVED BY PWS
Type of
Structure












location
















Contact Pvnott
Name












Phone












LSI













Home
PturrtWno;












*-












VduiK
teerW












Selac^d
Rootirw












OptiOMl












Iteeerved
Training
Material












                                                                                            o
                                                                                            o
                                                                                           I
                                                                                            o
                                                                                            5!

                                                                                            3"
                                                                                            •o
                                                                                            I
                                                                                           I
                                                                                            5?

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WORKSHEET #2
              MATERIALS SURVEY RESULTS BY NUMBER OF SERVICE CONNECTIONS
                          FOR EACH PLUMBING MATERIALS TYPE
PWS ID NUMBER
POPULATION SERVED BY PWS
                                                                                     o

                                                                                     o

                                                                                     1
                                                                                     O
                                                                                     3
                                                                                     1982
Copper with
Lead Solder
<1983
Number of Service Connections












Distribution System Piping
LSLa
Entire Une
Partial Une
Number of Service Connections








                                                                                     in

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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
Plumbing 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
MFR [ BLDG
H umber of Service Connection*














•













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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—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 at least 1 tap water sample at a minimum of 10 sites every
   6 months.
   • All sites must meet Tier 1 targeting criteria.
   • 5 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).
 How Many Tap Water Samples Should I Collect After
 Installing Optimal Corrosion Control Treatment?

 • You  must collect 1 tap water sample at a minimum of 10 sites during each of
   2 consecutive 6-month monitoring periods.
   • All sites must meet Tier 1 targeting criteria.
   • 5 sites must 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 5 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 Many Tap Water Samples Should I Collect Alter the
 State Sets Water duality Parameters?

 • You must collect 1 tap water sample at a minimum of 10 sites every 6 months.
   • All sites must meet Tier 1 targeting criteria.
   • 5 sires 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
 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 5 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 10 to 5, 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 5 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 5 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 9Oth Percentile Lead and Copper Levels
  During Initial, Follow-up and Routine Monitoring?

  • When 40 samples are collected,  the 2nd highest sample value recorded during a
   6-month monitoring period is the 90th percentile.
  • If the 2nd 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 2nd 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 90th Pcrccntilc Lead and Copper Levels
  During Reduced Monitoring?

  • When 5 samples are collected, the average of the 4th and 5th highest sample value
    recorded during a reduced monitoring period is the 90th percentile.

  • If the average of the 4th and 5th highest lead level exceeds 15 ppb you must:
    •  Stop monitoring at a  reduced number and frequency,  and recommence
      collecting 10 tap water samples every 6 months, immediately.
    •  If  you  have not  installed  optimal  corrosion control  treatment, start
      collecting 2  WQP samples every 6 months at 1 site 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 1 site 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 average of the 4th and 5th highest copper level exceeds 1.3 ppm you must:
    •  Stop monitoring at a  reduced number and frequency,  and recommence
      collecting 10 tap water samples every 6 months, immediately.
    •  If  you  have not  installed  optimal  corrosion control treatment, start
      collecting 2  WQP samples every 6 months at  1 site 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 1 site 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 for Public Water Systems
Calculating the 9Ot
3&itial, Follow-up and
•&
Sample Number
1
2
3
4
5
Sample Value
0
0
0
0
6
h Percentile During
I Routine Monitoring
Sample Number
6
7
8
9 (90th %)
10
Sample Value
10
12
20
25
30
                 Calculating the 90th Percentile
                   During Reduced Monitoring
                  Sample Number

                        1
                        2
                        3
                        4
                        5

                    (Average of
                 4 and 5 is 90th %)
Sample Value

     0
     0
     6
     8
     12
    10

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   Page 14 — Monitoring Guidance for Public Water Systems


                            Suggested Directions for

          Homeowner Tap Sample Collection Procedures

                                         **•
  fThese 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	at	if you have any questions regarding these
instructions.
     TO BE COMPLETED BY RESIDENT
                  ->X A-

     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 representative site located in 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 Sampling Sites for Water
 Quality Parameters?

 • You must identify 1 sampling site in your distribution system representative of
    the water quality throughout the distribution system. For ease, you may want to
    use a site 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 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 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-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.

-------
Page 17 — Monitoring Guidance for Public Water Systems
            How and  When You  Should Collect
             Water Quality Parameter  Samples
  How Do 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 40 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.
     •   // 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 Collect
  in the Monitoring Period in Which an Action Level Is Initially
  Exceeded?
                                              *
  •  Collect WQP samples at a representative site 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 1 site located in 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 for Public Water Systems
            How and When You  Should Collect
             Water Quality Parameter Samples
  How Many Water Quality Parameter Samples Should I Collect
  After y»t»t**K**g 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 1 site 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 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).

-------
Page 20 — Monitoring Guidance for 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 Valises?

 • 2 samples  must be collected at 1 sampling site 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 Water Quality Parameter Samples Should X 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 1 site in the
    distribution system from biannually to annually.

 • If you maintain  the state-specified values for  WQPs at  1 site in your
    distribution system for 3 consecutive years you may reduce the frequency with
    which you collect 2 WQP samples at 1 site 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.

-------
Page 21 — Monitoring Guidance for Public Water 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 Copper Source Water Sample*?

 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.

-------
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
 CoUect 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, 1993 to January 2, 1994) you must collect source  water
       samples and submit the results to the state by July 1, 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).
 How Many Lead and Copper Source Water Samples Should X
 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.

-------
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 Sets 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 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 Lead and Copper Source Water Samples Should i
 Collect During Reduced 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-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.

-------
Tap Wafer Monitoring Requirements For Small Water Systems (101  to 500)
                    Reduced numtMt at iampkia
                              PWCu^Artton Uwri n«»» morttor won al each «r*y poM
                    ID tt« 
-------
 Source Water Monitoring For  Lead and Copper For Small  Systems (£3,300)
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-------
   Number'and Frequency of Tap Water Monitoring For Systems Demonstrating Optimal Corrosion Control  Treatment  Installed

     901 to 1X0
<[jy«terti> t^rvtogT^

        I
                              • Numbar o» ittm h dbMbullon iy«t«m whew PWS mu»t cotoct Ivxo (Z) nrptot to oppfcobto WQPi.

                             • • Syitam cotoct two (2) tcrrptot at «ach Ma tor: pH. ahdMty. cddum. conductMly. water terroaratura. orthaphatphatft
                               (wt»n pho«phate InhUtor UMd). and rttea (wrv»n Ofcoto inHbltor uMd).
                              » State jttootv«t9morxl^o^

                             tt Larga water lyttamt damoratratho OCCT with loriiptm tfxiiwlng that ti« dltai«nc« b*lw0«n tap water and iourc« water
                               toad tovak ore < S ppb muit cotoct WOP nmptoi to lh» itat* can wt vdUM txit rafloct optimal corrodon control.

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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 NTNCWS
Size: D > 100,000
D 10.001 to 100.000
D 3.301 to 10.000
D 501 to 3.300
Telephone number
System ID #:
Contact Person:
D 101 to SOO
n sioo



                         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)

-------
  - Page 28 — Monitoring Guidance tor Public Water Systems

Form 141-A (continued)                                                                Page 2 of 3
               SAMPLE SITE IDENTIFICATION AND CERTIFICATION
                         CERTIFICATION OF SAMPLING SITES
 LEAD SERVICE LINE SITES
 0 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 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):
                     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 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
f 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 SAM RUNG 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: D > 100,000
D 10.001 to 100.000
D 3.301 to 10.000
D 501 to 3.300
Telephone number:
Svstem ID #:
Contact Person:
D 101 to 500
n sioo



                            REQUEST FOR REDUCTION
   The
                     water system has:
   D maintained tap water levels below the lead/copper action level(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 lead and
   copper tap water monitoring from:
            n Biannual to Annual

            D Annual to Triennial
            D  100 to 50
            D  60 to 30
            D  40 to 20
            D  201010
            D  10 to 5
   The results of ail 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
                                                                          e 1 of 2
  OPTIMAL CORROSION CONTROL TREATMENT/WATER QUALITY PARAMETER
System's Name:
Address:

Tvoe: D CWS n NTNCWS
Size: D >100,000
n 10.001 to 100.000
D 3.301 to 10.000
D 501 to 3.300
Telephone number
System ID #:
Contact Person:
a 101 to soo
a sioo



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

_f 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
After










Parameters
Pb
Cu
pH
alkalinity
calcium
conductivity
orthophosphate
silicate
water
temperature
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 TREAT ME NT/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
WATER QUALITY PARAMETERS
TREATMENT AND/OR
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:
Tree: D CWS D NTNCWS
Size: O > 100,000
a 10.001 to 100.000
D 3.301 to 10.000
D 501 to 3.300
Telephone number:
a 101 to soo
a sioo
System ID #:
Contact Person:

SOURCE WATER DATA
Attach al data collected a! all ertry points to the distribution system. List the highest values obtained fo
sampling for this mentoring period ami attach the resiAs of Softer samples coJtectedai each ertiy -
point .-. .-,-•* ' •-'•:.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Efitfv Point Location











Pb Values










Cu Value*











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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
SbURCE 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 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 MAXfMUM
                 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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