SEPA
United States
Environmental Protection Agency
    Preventive Maintenance Card File for
    Small Public Water Systems Using
    Ground Water
    Log Cards

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Office of Water (4606M)
EPA816-B-04-002
December 2004
vwwv.epa.gov/safewater
                                                 Printed on Recycled Paper

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     Tools For Preventive Maintenance
These log cards, along with the accompanying guidance notes booklet, provide a schedule of routine
operation and maintenance tasks for small ground water systems. The cards and booklet will help you
develop a preventive maintenance program for your system.  The cards also provide some security
measures water systems need to do to help prevent loss of service through terrorist acts, vandalism,
or mischief.

The cards are divided into sections that list daily, weekly, and monthly tasks, with individual sections
that outline specific tasks for each month of the year. They correspond to the guidance notes in the
booklet. Each section of cards contains a list of suggested tasks to be carried out for that time period
and log  cards to record information. We have not included log cards for every task because some
tasks can be completed without recording anything. Tasks that do not have log cards are in italicized
print.

You should copy all of the blank log cards for future use.  Each log card has space for additional
comments.  A follow-up log card, included at the end of this card set, can be used to record any
problems you encounter and to help you keep a schedule for any needed repairs or replacements.
Please review the guidance notes in the accompanying booklet, which provide additional information
on some tasks. Note that we have not defined all tasks because some are self-explanatory. A contact
list is provided in the accompanying cards if you need additional information.

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This side intentionally left blank.

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I REFERENCE
                   REFERENCE
                                              REFERENCE
                  REFERENCE!
             Emergency Notification/Contact Information
Water System Name_
PWSID#
                                              Pop. Served_
Owner Name
Water System Operator_



       Phone (Night)_
Owner Phone



Phone (Day)	



Phone (Cell)_
Organization
Safety Officer
Supervisors
Ambulance
Fire Department
Contact Name




Phone (Day)




Phone (Cell)




Phone (Night)





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I REFERENCE
                   REFERENCE
                                             REFERENCE
REFERENCE!
             Emergency Notification/Contact Information
Organization
Police Department
Hospital
Poison Control
FBI Field Office
Health Department
Primacy Agency
Well Driller
Chemical Supplier
Local Emergency
Planning Committee
Contact Name









Phone (Day)









Phone (Cell)









Phone (Night)










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I REFERENCE
                   REFERENCE
                                             REFERENCE
REFERENCE!
             Emergency Notification/Contact Information
Organization
Designated Water
System Spokesperson
Local Government
Official
Local Hazmat Team
Other Operators
Neighboring Water
System
Neighboring Water
System
Television
Radio
Contact Name








Phone (Day)








Phone (Cell)








Phone (Night)









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REFERENCE REFERENCE REFERENCE REFERENCE
Emergency Notification/Contact Information
Organization
Other:
Other:
Other:
Contact Name



Phone (Day)



Phone (Cell)



Phone (Night)




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I REFERENCE              REFERENCE                          REFERENCE              REFERENCE I

                                       Contacts
For more information, contact:

U.S. EPA Headquarters	
            Office of Ground Water and Drinking Water
            (202) 564-3750  http://vwwv.epa.gov/OGWDW/


U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites	
EPA Region 1                                (617)918-1584  www.epa.gov/region1/eco/
                                                           drinkwater/index.html
Connecticut                                  (860) 509-7333  www.state.ct.us/dph/BRS/
Department of Public Health: Drinking Water Division                WSS/water_supplies.htm
Maine                                       (207) 287-2070  www.state.me.us/dhs/eng/
Maine Department of Human Services: Division of                  water/index.htm
Health Engineering
Massachusetts                               (617)292-5770  www.state.ma.us/dep/brp/dws/
Department of Environmental Protection: Drinking                   dwshome.htm
Water Program

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I  REFERENCE
                         REFERENCE
                                                            REFERENCE
                                     REFERENCE!
                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites
New Hampshire
Department of Environmental Services: Water Supply
Engineering Bureau
Rhode Island
Department of Health: Office of Drinking Water
Quality
Vermont
Department of Environmental Conservation: Water
Supply Division

EPA Region 2

New Jersey
Department of Environmental Protection: Bureau of
Safe Drinking Water
New York
Department of Health: Bureau of Public Water Supply
Protection
(603) 271 -2513  www.des.state.nh.us/wseb/


(401)222-6867


(802) 241 -3400
www.healthri.org/environment/dwq/
home.htm
www.anr.state.vt.us/dec/watersup/
wsd.htm
(212) 637-3879  www.epa.gov/region02/water/
               drinktop.htm
(609) 292-5550  www.state.nj.us/dep/
               watersupply/safedrnk.htm

(518) 402-7650  www.health.state.ny.us/
               nysdoh/water/main.htm

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I  REFERENCE
                         REFERENCE
                                                            REFERENCE
                                     REFERENCE!
                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites
Puerto Rico
Department of Health: Public Water Supply
Supervision Program
Virgin Islands
Department of Planning & Natural Resources:
Division of Environmental Protection

EPA Region 3
Delaware
Health & Social Services: Division of Public Health
District of Columbia
Department of Health
Maryland
Department of the Environment: Public Drinking
Water Program
Pennsylvania
Department of Environmental Protection: Bureau of
Water Supply Management
(787) 977-5870  www.epa.gov/region02/cepd/
               prlink.htm

(340) 774-3320  www.dpnr.gov.vi/dep/
               publicwatersup.htm
(215) 814-2300  www.epa.gov/reg3wapd/
(302) 739-4731   www.state.de.us/dhss/dph/hsp.htm

(202) 442-5999  www.dchealth.dc.gov/index.asp

(410) 631 -3702  www.mde.state.md.us/
(717) 787-5017  www.dep.state.pa.us/dep/deputate/
               wate rmgt/wsm/wsm .htm

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I  REFERENCE               REFERENCE                          REFERENCE               REFERENCE  I

                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites	
Virginia                                       (804) 786-5566  www.vdh.state.va.us/ddw/index.htm
Department of Health: Division of Drinking Water
West Virginia                                  (304) 558-2981  www.wvdhhr.org/oehs/eed/
Bureau for Public Health: Environmental Engineering
Division

EPA Region 4                                  (404)562-9345  www.epa.gov/region4/water/
Alabama                                      (334)271-7773  www.adem.state.al.us/
Department of Environmental Management: Water                  waterdiv/drinking%20water/
Supply Branch                                                 dwmaininfo.htm
Florida                                       (850)487-1762  www.dep.state.fl.us/water/
Department of Environmental Protection: Drinking                   drinkingwater/index.htm
Water Section
Georgia                                       (404) 656-6328  www.ganet.org/dnr/environ/
Department of Natural Resources: Water Resources
Branch
                                                                                            10

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I  REFERENCE               REFERENCE                          REFERENCE               REFERENCE  I

                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites	
Kentucky                                     (502)564-3410  water.nr.state.ky.us/dw/
Department for Environmental Protection: Drinking
Water Branch
Mississippi                                    (601)576-7518  www.msdh.state.ms.us/
Department of Health: Public Water Supply Program                 watersupply/index.htm
North Carolina                                (919)715-3232  www.deh.enr.state.nc.us/pws
Department of Environment and Natural Resources:
Public Water Supply Section
South Carolina                                (803) 898-4300  www.scdhec.net/water/html/
Department of Health & Environmental Control:                     dwater.html
Bureau of Water
Tennessee                                    (615)532-0191  www.state.tn.us/environment/
Department of Environment & Conservation: Division                 dws/index.html
of Water Supply

EPA Region 5                                  (312)886-6206  www.epa.gov/region5/water/gwdw
Illinois                                        (217)785-8653  www.epa.state.il.us/water/
Environmental Protection Agency: Bureau of Water
                                                                                            11

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I  REFERENCE               REFERENCE                          REFERENCE               REFERENCE  I

                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites	
Indiana                                       (317)308-3282  www.state.in.us/idem/owm/
Department of Environmental Management: Drinking                 dwb/index.html
Water Branch
Michigan                                      (517)335-9218  www.michigan.gov/deq/
Department of Environmental Quality: Drinking Water                0,1607,7-135-3313_3675-,00.html
Program
Minnesota                                     (612)215-0770  www.health.state.mn.us/divs/
Department of Health: Drinking Water Protection                    eh/water/index.html
Section
Ohio                                          (614)644-2752  www.epa.state.oh.us/ddagw/
Environmental Protection Agency: Division of
Drinking & Ground Waters
Wisconsin                                     (608) 266-2299  www.dnr.state.wi.us/org/water/dwg/
Department of Natural Resources: Bureau of Drinking
Water and Ground Water

EPA Region 6                                  (214)665-2757  www.epa.gov/region6/
Arkansas                                     (501)661-2623  www.healthyarkansas.com/
Department of Health: Division of Engineering                       eng/index.html


                                                                                            12

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I  REFERENCE
                         REFERENCE
                                                            REFERENCE
                      REFERENCE!
                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites
Louisiana                                     (225) 765-5038
Office of Public Health: Center for Environmental
Health
New Mexico                                   (877) 654-8720
Environment Department: Drinking Water Bureau
Oklahoma                                     (405)702-8100
Department of Environmental Quality: Water Quality
Division
Texas                                        (512)239-4300
Commission on Environmental Quality

EPA Region 7                                  (913) 551 -7030

Iowa                                         (515) 725-0275
Department of Natural Resources: Water Supply
Section
Kansas                                       (785) 296-5503
Department of Health & Environment: Public Water
Supply Section
www.dhh.state.la.us/OPH/
safewtr.htm

www.nmenv.state.nm.us/dwb/
dwbtop.html
www.deq.state.ok.us/wqdnew/
index.htm

www.tnrcc.state.tx.us/permitting/
wate rpe rm/pd w/pd wOOO. htm I

www.epa.gov/region07/water/
dwgw.html
www.state.ia.us/government/
dnr/organiza/epd/wtrsuply/
wtrsup.htm
www.kdhe.state.ks.us/water/
pwss.html
                                                                                            13

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I REFERENCE
                         REFERENCE
                                                            REFERENCE
                                     REFERENCE!
                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites
Missouri
Department of Natural Resources: Public Drinking
Water Program
Nebraska
Health & Human Services System: Public Water
Supply Program

EPA Region 8
(573) 751 -5331


(402) 471 -2541




(303)312-6312

(303) 692-3500
Colorado
Department of Public Health & Environment: Drinking
Water Program
Montana                                     (406) 444-4400
Department of Environmental Quality: Public Water
Supply Section
North Dakota                                 (701) 328-5211
Department of Health: Drinking Water Program
www.dnr.state.mo.us/deq/
pdwp/homepdwp.htm

www.hhs.state.ne.us/enh/
pwsindex.htm
www.epa.gov/region08/water/
dwhome/dwhome.html
www.cdphe.state.co.us/wq/
drinking_water/
drinking_water_program.htm
www.deq.state.mt.us/pcd/csb/pws/
index.asp

www.ehs.health.state.nd.us/
ndhd/environ/mf/index.htm
                                                                                           14

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I  REFERENCE               REFERENCE                           REFERENCE               REFERENCE I

                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites	
South Dakota                                  (605) 773-3754   www.state.sd.us/denr/des/
Department of Environment & Natural Resources:                    drinking/dwprg.htm
Drinking Water Program
Utah                                          (801)536-4200   http://drinkingwater.utah.gov
Department of Environmental Quality: Division of
Drinking Water
Wyoming                                      (303)312-6312   www.epa.gov/region08/water/
EPA Region 8: Wyoming Drinking Water Program                    dwhome/wycon/wycon.html

EPA Region 9                                  (415)972-3547   www.epa.gov/region9/water
American Samoa                               (415)972-3767   www.epa.gov/Region9/
Environmental Protection Agency: American Samoa                  cross_pr/islands/samoa.html
Arizona                                       (602)771-4644   www.adeq.state.az.us/environ/water/
Department of Environmental Quality: Drinking Water                 dw/index.html
Section
California                                      (916)323-6111   www.dhs.cahwnet.gov/org/ps/ddwem/
Department of Health Services: Division of Drinking
Water & Environmental Management
                                                                                           15

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I REFERENCE               REFERENCE                           REFERENCE               REFERENCE  I

                                         Contacts
U.S. EPA Regional, State, and Primacy Agency Phone Numbers and Websites	
Guam                                         (671)472-8863   www.epa.gov/region09/
Environmental Protection Agency: Guam                           cross_pr/islands/guam.html
Hawaii                                        (808) 586-4258   www.hawaii.gov/health/eh/
Department of Health: Safe Drinking Water Branch                   eiemdwOO.htm
Nevada                                       (775)687-6615   www.state.nv.us/health/bhps/
Department of Human Resources: Bureau of Health                  sdwp.htm
Protection Services

EPA Region 10                                 (206)553-1893   www.epa.gov/region10/
Alaska                                        (907) 269-7653   www.state.ak.us/dec/deh/
Department of Environmental Conservation: Drinking                 safewater.htm
Water & Wastewater Program
Idaho                                         (208) 373-0502   www2.state.id.us/deq/water/
Department of Environmental Quality: Water Quality                  water! .htm
Oregon                                       (503)731-4010   www.ohd.hr.state.or.us/dwp/
Department of Human Services: Drinking Water                     welcome.htm
Program
Washington                                   (360)236-3100   www.doh.wa.gov/ehp/dw/
Department of Health: Division of Drinking Water


                                                                                           16

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I REFERENCE
                       REFERENCE
                                                        REFERENCE
                                              REFERENCE!
                                      Contacts
Additional Contacts
 National Rural Water Association
 State Rural Water Associations
 Rural Community Assistance
 Program

 Rural Utilities Service
 Safe Drinking Water Hotline

 EPA National (24-hour)
(580) 252-0629
http://vwwv.nrwa.org/
For associations listed by State,
see:
http://vwvw.nrwa.org/2001/member
s/assnlist.htm
(203)408-1273
(888)321-7227
http://www.rcap.org
(202) 690-2670
http://www.rurdev.usda.gov/rus/index.html


7-800-426-4797
hotline-sdwa@epa.gov
1-800-424-8802
                                                                                      17

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I  REFERENCE                REFERENCE                            REFERENCE               REFERENCE I

                                          Contacts

  Technical Assistance Centers	

  Alaska                                          (907) 747-7756   http://www.uas.alaska.edu/attac/
  Alaska Training/Technical Assistance Center
  (ATTAC)

  Illinois                                          (217)333-9321    http://mtac.sws.uiuc.edu
  Midwest Technology Assistance Center MTAC

  Kentucky                                        (270) 745-5948   http://water.wku.edu/
  Center for Water Resource Studies

  Mississippi                                      (662) 325-3620   http://www.wrri.msstate.edu
  Mississippi Water Resources Research Institute

  Missouri                                         (573) 882-7564   http://web.missouri.edu/~mowrrc
  Missouri Water Resources Research Center

  Montana                                         (406) 994-6690   http://water.montana.edu
  Montana Water Center
                                                                                              18

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I  REFERENCE
                         REFERENCE
                                                            REFERENCE
                                   REFERENCE!
                                         Contacts
 Technical Assistance Centers
  New Hampshire
  New England Water Treatment Technology
  Assistance Center
(603) 862-4334   http://www.unh.edu/erg/wttac/
  Pennsylvania                                   (717)948-6358   http://www.hbg.psu.edu/spwstac/
  Small Public Water Systems Technology Assistance                   main.html
  Center at Penn State Harrisburg
 West Virginia
 National Drinking Water Clearinghouse
(800) 624-8301    http://www.ndwc.wvu.edu
                                                                                           19

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I  REFERENCE
                          REFERENCE
                                                              REFERENCE
                                     REFERENCE!
                                          Contacts
  Environmental Finance Centers
  California
  Environmental Finance Center Region 9

  Idaho
  Environmental Finance Center

  Kentucky
  Southeast Regional Environmental Finance Center

  Maryland
  The Environmental Finance Center, University of
  Maryland

  New Mexico
  NM Environmental Finance Center
(510) 749-6867   http://www.greenstart.org/efc9/
(208) 426-1567    http://sspa.boisestate.edu/efc/
                 index.htm

(502) 852-8032    http://cepm.louisville.edu/org/
                 SEEFC/seefc.htm

(301) 405-6383    http://www.efc.umd.edu/
(505) 272-7357    http://efc.nmt.edu/
                                                                                              20

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I  REFERENCE               REFERENCE                           REFERENCE               REFERENCE I

                                          Contacts

  Environmental Finance Centers

  New York                                      (315)443-3759   http://www.maxwell.syr.edu/efc/
  Environmental Finance Center at Syracuse
  University's Maxwell School of Citizenship and
  Public Affairs

  North Carolina                                 (919)843-4956   http://www.unc.edu/depts/efc/
  UNC  Environmental Finance Center

  Ohio                                           (216)687-2188   http://www.csuohio.edu/glefc/
  Great Lakes Environmental Finance Center
                                                                                             21

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I REFERENCE              REFERENCE                         REFERENCE              REFERENCE I
                           This side intentionally left blank.
                                                                                       22

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I REFERENCE           REFERENCE                    REFERENCE            REFERENCE I




       Commonly Used Conversion Factors
 1 foot = 12 inches
 1 pint = 16 ounces
 1 pound = 16 ounces
 1 quart = 2 pints = 32 ounces
 1 gallon = 3.785 liters
1 liter = .264 gallons
 1 square foot (sq. ft.) = 144 square inches (sq. in.)
 1 cubic foot (cu. ft.) = 7.48 gallons (gal.)
 1 acre foot (ac. ft.) = 43,560 cu. ft. = 325,829 gal.
                                                                      23

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I REFERENCE          REFERENCE                  REFERENCE          REFERENCE I




       Commonly  Used Conversion Factors
 1 gallon per minute (gpm) = 1,440 gallons per day (gpd)
 1 cubic foot per second (cfs) = 646,272 gpd = 448.8 gpm
 1 million gallons per day (MGD) = 1.55 cfs = 694.4 gpm
1 part per million (ppm) = 1 milligram per liter (mg/L)
= 8.34 pounds per million gallons
1 .0 pounds per square inch (psi) = 2.31 feet of head
1 .0 feet head = 0.433 psi
1 horsepower = 550 foot-pounds per second
                                                               24

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I REFERENCE        REFERENCE              REFERENCE        REFERENCE I




          Commonly Used Formulas
Area = Length x Width
Chemical dosage: pounds per day (Ibs./day) = MGD
x ppm x 8.34 Ibs./gal.
Circular area = • r2 (• • 3.14) OR circular area = 0.785x diameter (D)2
Circular volume = Width x Length x Height
Circumference = 2* r (where • • 3.14; r = radius)
CT = Chlorine concentration (mg/L) x time (minutes)
Detention time = tank volume (gallons)
Flow (gpm or gpd)

Perimeter (of rectangle) = 2(length) + 2(width)
Perimeter for other shapes= add lengths of all sides
                                               25

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I REFERENCE        REFERENCE              REFERENCE        REFERENCE I




          Commonly Used Formulas
Flow rate (Q, ft.3/sec.) = Velocity (ft./sec.) X Area (ft
2)
Force = Pressure (psi) x Area (in.2)
Pounds per gallon (not water) = Specific Gravity x 8
Specific capacity = flow (qpm)
drawdown (ft.)
34

Water horsepower = Q (flow in gpm) x H (feet head)
3,960
                                               26

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I REFERENCE
                       REFERENCE
                                                        REFERENCE
REFERENCE!
                              Water Line Repairs Log*
Date





Location





Size





Replaced/Repaired





Comments





"Remember to photocopy the log card for future use before filling it out.
                                 See Guide Book Page 4
       27

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REFERENCE REFERENCE REFERENCE REFERENCE

Date






Location






Size






Replaced/Repaired






Comments






"Remember to photocopy the log card for future use before filling it out.
                                   See Guide Book Page 4
28

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I DAILY                DAILY                            DAILY               DAILY I
     Recommended Daily Operational  Duties
• • Check water meter readings and record water production.
• • Check chemical solution tanks and record amounts used.
• • Check and record water levels in storage tanks.
• • Inspect chemical feed pumps.
• • Check and record chlorine residual at the point of application.
• • Check and record chlorine residual in the distribution system.
• • Inspect booster pump stations.
• • Check and record fluoride  concentration in the distribution system.
• • Record well pump running times and pump cycle starts.
                                                  (Continued on other side of card.)

                         See Guide Book Pages 5-11                        29

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I DAILY                DAILY                              DAILY                DAILY I

   Recommended Daily Operational Duties
 • Check instrumentation for proper signal input/output.
   ••   Chlorine residual
   ••   Fluoride

 • Investigate customer complaints. Use special "Telephone Threat" card to record threats
   or suspicious activity.

 • Complete a daily security check.
   ••   Check all windows, doors, hatches, seals and vents for evidence of vandalism or tampering.
   ••   Check all well caps, seals, and vents to ensure that they are intact and sealed.
   ••   Check all security lighting to ensure proper operation.

 • Inspect heater operation during winter months.

 • Inspect well pumps, motors, and controls.
                          See Guide Book Pages 11 & 12
                     (Reminder: italicized tasks do not have log cards)                    30

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I DAILY
                        DAILY
                                                             DAILY
DAILY |
            Daily Water Production Log Card*  Month/Year _
Date
15"
14"
13"
12"
11"
10P
9<"
8th
7"1
6th
5"1
4".
3'"
2nd
1""
Meter Reading















Amount of Water Used















Notes or Comments















"Remember to photocopy the log card for future use before filling it out. "The first value should go here.
                                 See Guide Book Page 5
   31

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I DAILY
                        DAILY
                                                               DAILY
DAILY |
Date
Meter Reading
Total Water Produced"""1
31"
30"
29"
28"
27"
26"
25"
24"
23a
22">
21"
20"
19"
18"
17"
16"
















Amount of Water Used

















Notes or Comments

















"""Subtract reading from the 1st of the month from last reading of the month.
                                  See Guide Book Page 5
   32

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I DAILY
                       DAILY
                                                            DAILY
DAILY |
Chemical Pump Settings: Speed
                   Daily Chemical Solution Usage Log Card*
                                          Stroke
                                                                   Month/Year
Date

15th
14th
13th
12th
11th
10th
9th
8<"
7th
6th
5th
4th
3"
ond
4St**
Water Prod.
(From Prod.
Card)















Chlorine
Solution
Used















Chlorine Used
per qal
water produced















Any C/2 Dosage
Failures &
Duration
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
Fluoride
Solution
Used















Fluoride Used per
cial water
produced















"Remember to photocopy the log card for future use before filling it out "The first value of the month should go here.
                                See Guide Book Page 5                               33

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I  DAILY
                          DAILY
                                                                    DAILY
DAILY  |
Date

31"
30"
29"
28"
27"
26"
25"
24"
23a
22M
21"
20"
19"
18"
17"
16"
15"
Water Prod.
(From Prod.
Card)

















Chlorine
Solution
Used

















Chlorine Used per
gal Water
Produced

















Any C/2 Dosage
Failures &
Duration
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
Fluoride
Solution
Used

















Fluoride Used per
gal Water
Produced

















"Remember to photocopy the log card for future use before filling it out "The first value of the month should go here.
                                     See Guide Book Page 5                                   34

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I DAILY
                       DAILY
                                                           DAILY
DAILY |
               Daily Chemical Solution Usage Log Card - Other*
Chemical Pump Settings: Speed	Stroke	       Month/Year
Date
14th
13"
12th
11"
10*
9»
8*
7"
6"
5"
4th
y
T"
1"**
Water Prod.
(From Prod.
Card)














Solution
Used














Solution Used
per qal
Water Produced














Test Results
Raw & Treated














Backwash meter
reading and/or
cycles














"Remember to photocopy the log card for future use before filling it out "The first value of the month should go here.
                                See Guide Book Page 7                              35

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I  DAILY
                          DAILY
                                                                     DAILY
DAILY  |
Date
31"
30"
29"
28"
27"
26"
25"
24"
23"
22nd
21"
20"
«"
fS"
11*
f6"
f5"
Water Prod.
(From Prod.
Card)

















Solution
Used

















Solution Used per
gal Water
Produced

















Test Results
Raw & Treated

















Backwash meter
reading and/or
cycles

















"Remember to photocopy the log card for future use before filling it out ""The first value of the month should go here.
                                     See Guide Book Page 7                                  36

-------
I DAILY
                       DAILY
                                                            DAILY
DAILY |
          Daily Storage Tank Water Level Log Card*  Tank NO.	

 Month/Year              Normal Operational Range of Tank Levels (High & Low)_
Date
1st
2nd
3"
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
Water Level (in ft.)














Action Taken














System Pressure (at tank)














Time of
Reading














"Remember to photocopy the log card for each tank and for future use before filling it out.
                                See Guide Book Page 7
   37

-------
I  DAILY
                          DAILY
                                                                    DAILY
DAILY |
Date
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25'"
26'"
27'"
28'"
29'"
30'"
31st
Water Level (in ft.)

















Action Taken

















System Pressure (at tank)

















Time of
Reading

















"Remember to photocopy the log card for each tank and for future use before filling it out.
                                     See Guide Book Page 7
   38

-------
I DAILY
                       DAILY
                                                            DAILY
DAILY |
         Daily Pressure Tank Water Level Log Card*  Tank NO.
 Month/Year
                        Normal Operational Range of Tank Levels (High & Low)_
Date
1"
2nd
y
4th
5"
6"
7"
8*
9»
10*
11"
12th
13th
14'"
1S*
Water Level (in ft.)















System Pressure
(at tank)















Time of Reading















Action Taken















"Remember to photocopy the log card for each tank and for future use before filling it out.
                                See Guide Book Page 7
   39

-------
I  DAILY
                          DAILY
                                                                    DAILY
DAILY |
Date
16?"
17*
18"
19th
20"
21"
22nd
23"
24'"
25"
26"
27"
28"
29"
30"
31"
Water Level (in ft.)
















System Pressure
(at tank)
















Time of Reading
















Action Taken
















"Remember to photocopy the log card for each tank and for future use before filling it out.
                                     See Guide Book Page 7
   40

-------
I DAILY
                       DAILY
                                                             DAILY
DAILY |
         Daily Chemical Feed Pump Log Card*  Month/Year _
           Dosage Calculation = (ax b)/c = d (Make sure to include units of measurement.)
Day
14"
13"
12"
11"
10"
gtl,
8th
7"1
6th
5"
f
3a
2""
*"**
Concentration of
Chemical Solution
(a)














Volume of
Solution Pumped
(b)














Volume of
Water Treated
(c)














Calculated
Dosage (mg/L)
(d)














Expected
Dosage














"Remember to photocopy the log card for future use before filling it out. "First Value of month should go here.
                                 See Guide Book Page 8
   41

-------
I DAILY
                        DAILY
                                                              DAILY
DAILY |
Day
iff"
iff*
17"
fS"
19th
20"
21"
22nd
23"
24"
25"
26"
27"
28"
29"
30"
31"
Concentration of
Chemical Solution
(a)

















Volume of
Solution Pumped
(b)

















Volume of
Water Treated
(c)

















Calculated
Dosage (mg/L)
(d)

















Expected
Dosage

















                                 See Guide Book Page 8
   42

-------
I DAILY
                        DAILY
                                                              DAILY
DAILY |
           Daily Chlorine Residual Log Card* Month/Year _
                             Location
Day
1st
ond
3"
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
Chlorine Residual (in mg/L) at
Point of Application
Target Level 	 mg/L to 	 mg/L














Chlorine Residual (in mg/L) in
Distribution System
(include sample location)














Notes or Comments














"Remember to photocopy the log card for future use and for multiple sampling locations before filling it out.
                                 See Guide Book Page 9
   43

-------
I DAILY
                        DAILY
                                                              DAILY
DAILY |
Day
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
Chlorine Residual (in mg/L) at
Point of Application
Target Level 	 mg/L to 	 mg/L

















Chlorine Residual (in mg/L) in
Distribution System
(include sample location)

















Notes or Comments

















                                 See Guide Book Page 9
   44

-------
I DAILY
                       DAILY
                                                           DAILY
DAILY |
            Daily Booster Pump Log Card* Month/Year _
Day
1"
2nd
3'"
4".
5"1
6"
7"1
8th
9<"
10"
11"
12"
13"
14"
15*
Are Pump Operating Times
Equalized?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Meter Readings
Run Time















Starts















Pressure Gauge Readings
Suction Side















Discharge Side















Pump on/off















"Remember to photocopy the log card for future use before filling it out.
                               See Guide Book Page 10
   45

-------
I  DAILY
                          DAILY
                                                                   DAILY
DAILY |
Day
16"
17"
18"
19"
20th
21st
22M
23a
24th
25th
26th
27th
28th
29th
30th
31st
Are Pump Operating Times
Equalized?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Meter Readings
Run Time
















Starts
















Pressure Gauge Readings
Suction Side
















Discharge Side
















Pump on/off
















"Remember to photocopy the log card for future use before filling it out.
                                    See Guide Book Page 10
   46

-------
I DAILY
                       DAILY
                                                            DAILY
DAILY |
                     Daily Fluoride Concentration Log Card*
                 Predetermined Concentration        Month/Year
                            Sample Point Location
Day
1"
2""
3rt
4".
5"1
6th
7th
8th
9th
10th
11*
12th
13th
14th
Fluoride Concentration in
Distribution System














Adjustment Needed +/-














Notes or Comments














"Remember to photocopy the log card for future use before filling it out.
                                See Guide Book Page 10
   47

-------
I DAILY
                        DAILY
                                                             DAILY
DAILY |
Day
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
Fluoride Concentration in
Distribution System

















Adjustment Needed +/-

















Notes or Comments

















                                 See Guide Book Page 10
   48

-------
I DAILY
                       DAILY
                                                            DAILY
DAILY |
                            Daily Well Pump Log Card*
                               Month/Year
Date
1"
ynd
•yd
4".
5"1
6'"
T"
go,
9th
10"
11"
12"
13"
14"
15*
Running Time
(in Mrs.)















Number of Cycle
Starts















Notes or Comments















"Remember to photocopy the log card for future use before filling it out.
                                See Guide Book Page 11
   49

-------
I  DAILY
                          DAILY
                                                                   DAILY
DAILY |
Date
16"
17"
18"
19"
20"
21"
22nd
23a
24"
25"
26"
27"
28"
29"
30"
31"
Running Time
(in Mrs.)
















Number of Cycle
Starts
















Notes or Comments
















"Remember to photocopy the log card for future use before filling it out.
                                    See Guide Book Page 11
   50

-------
I DAILY
                     DAILY
                                                       DAILY
             Daily Instrumentation Equipment Check Log Card*
                 Type of Equipment	  Date	
•• Check to make sure the instrument is working-input/output signal.
•• Check to make sure proper flow is going to the instrument.

Per Manufacturer Specifications:
(Review operation manual and set the following per recommendations. Use this list for daily checks.)
DAILY |
Equipment Check
Verify all signals.
Calibrate input/output.
Clean as recommended.
Replace all standby
batteries/power (as needed).
Operation Manual Settings Notes




"Remember to photocopy the log card for each piece of equipment and for future use before filling it out.
                             See Guide Book Page 11
   51

-------
I DAILY               DAILY                             DAILY                DAILY I

         Other Instrumentation Equipment Notes or Comments
"Remember to photocopy the log card for each piece of equipment and for future use before filling it out.
                            See Guide Book Page 11                           52

-------
I DAILY
                      DAILY
                                                         DAILY
DAILY |
                       Customer Complaint Log Card*
Date







Questions, Concerns, or
Potential Problems
1.

Time Complaint Made

2.

Time Complaint Made
Customer Name
and Information







Person
Assigned/
Action Taken







Compliant
Resolved/
Researched

Time
resolved


Time
resolved
"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 11
   53

-------
I  DAILY
                          DAILY
                                                                   DAILY
DAILY |
Date







Questions, Concerns, or
Potential Problems
3.

Time Complaint Made

4.

Time Complaint Made
Customer Name
and Information







Person
Assigned/
Action Taken







Compliant
Resolved/
Researched

Time
resolved


Time
resolved
"Remember to photocopy the log card for future use before filling it out.
                                    See Guide Book Page 11
   54

-------
I  DAILY
                          DAILY
                                                                    DAILY
                                                                     DAILY |
             Water System  Telephone Threat Identification Checklist*
  1. Types of Tampering/Threat:
  • • Contamination
  • • Biological
  • • Chemical
• • Threat to tamper
• • Bombs, explosives, etc.
• • Other (explain)
                              2.  Call Received By (Name, Address, and
                              Telephone Number):
                                                      Date and Time of Call Received:
  3. Location of Tampering:
  • • Distribution Line
  • • Water Storage Facilities
  • • Treatment Plant
  • • Raw Water Source
  • • Treatment Chemicals
  • • Other
                              4. Contaminant Source and Quantity:

                              Date and Time of Tampering/Threat:

                              Caller's Name/Alias, Address, and Telephone
                              Number:
  5. Is the Connection Clear?
  (Could it have been a wireless or cell phone?)
                              6.  Is the Caller (check all that apply):
                                                      • • Male
                                                      • • Female
                                                      • • Impolite
                                                      • • Illiterate
                                                  Well Spoken
                                                  Irrational
                                                  Incoherent
"Remember to photocopy this card and ensure copies are available for use.
                                    See Guide Book Page 11
                                                                        55

-------
I  DAILY
                          DAILY
                                                                   DAILY
DAILY |
7. Is the Caller's Voice (Check all that apply):
• • Soft • • Calm • • Angry • • Slow
• • Slurred • • Loud • • Laughing • • Crying
• • Deep • • Nasal • • Clear • • Lisping
• • Old • • High • • Cracking • • Excited
• • Familiar (who did it sound like?)
• • Accented (which region or nationality?)
8. Are There Background Noises?
• • Street noises (what kind)
• • Machinery (what type?)
• • Voices (describe)
• • Children (describe)
• • Animals (what kind?)
• • Computer Keyboard, Office
• • Motors (describe)
• • Music (what kind?)
• • Other
• • Rapid
• • Normal
• • Stuttering
• • Young









"Remember to photocopy this card and ensure copies are available for use.
                                    See Guide Book Page 11
   56

-------
I DAILY                  DAILY                                 DAILY                 DAILY I

                    Daily Security Checklist*  Date	

        • •      Hatches -closed, locked
        • •      Doors -closed, locked
        • •      Windows -closed, intact, locked
        • •      Gates -closed, locked
        • •      Fences - intact
        • •      Well caps, seals, & vents - intact, sealed
        • •      Signs -visible, in good repair
        ••      Lights-working, available
        ••      Alarms-on, functioning
        • •      Work needed:
"Remember to photocopy this card and ensure copies are available for future use.
                               See Guide Book Page 12                             57

-------
I DAILY              DAILY                          DAILY              DAILY I




                     Other Notes and Comments
                                                                   58

-------
I DAILY              DAILY                          DAILY              DAILY I




                     Other Notes and Comments
                                                                   59

-------
I DAILY              DAILY                          DAILY              DAILY I




                     Other Notes and Comments
                                                                   60

-------
I WEEKLY             WEEKLY                       WEEKLY            WEEKLY I

   Recommended Weekly Operational Duties

• • Inspect chlorine and fluoride testing equipment.

• • Clean pump house and grounds.  Make sure fire hydrants are accessible.

• • Record pumping rate for each well or source water pump.

• • Conduct weekly security check.
  ••   Inspect all pump house plumbing for leaks.
  ••   Check all sump pumps for proper operation.
  ••   Check all station alarms.
  ••   Check backup power source to ensure it will operate when needed.
  "   Inspect fencing and gates.



                       See Guide Book Pages 13 -15                     61

-------
I WEEKLY                WEEKLY                              WEEKLY                WEEKLY I
                           This side intentionally left blank.
                                                                                      62

-------
I WEEKLY
                     WEEKLY
                                                      WEEKLY
WEEKLY |
             Weekly Chemical Equipment Testing Log Card*
                 Equipment	Month/Year	
Week
(Date)
1st
nnd
3rd
4*
5th
Is Equipment
Calibrated
Properly?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Are Reagents
Clearly Marked and
Safely Stored?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Are
Reagents
Expired?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Amount of
Reagent on
Hand





Notes or Comments





"Photocopy a log card for each chemical feeder. Remember to make copies for future use before filling log card out
                             See Guide Book Page 13                           63

-------
I WEEKLY
                     WEEKLY
                                                      WEEKLY
WEEKLY |
             Weekly Chemical Equipment Testing Log Card*
                 Equipment	Month/Year	
Week
(Date)
1st
nnd
3rd
4*
5th
Is Equipment
Calibrated
Properly?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Are Reagents
Clearly Marked and
Safely Stored?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Are
Reagents
Expired?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Amount of
Reagent on
Hand





Notes or Comments





"Photocopy a log card for each chemical feeder. Remember to make copies for future use before filling log card out
                             See Guide Book Page 13                           64

-------
I WEEKLY
                      WEEKLY
                                                       WEEKLY
WEEKLY |
                       Weekly Cleanliness Log Card*
                              Month/Year
Week
(Date)
1st
2nd
3rd
4*
5th
Are Pump House and
Grounds Clean?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Are Fire Hydrants
Accessible?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Notes or Comments





"Remember to photocopy the log card for future use before filling it out.
                           See Guide Book Pages 13 & 14
     65

-------
I WEEKLY
                      WEEKLY
                                                       WEEKLY
WEEKLY |
                       Weekly Cleanliness Log Card*
                              Month/Year
Week
(Date)
1st
2nd
3rd
4*
5th
Are Pump House and
Grounds Clean?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Are Fire Hydrants
Accessible?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Notes or Comments





"Remember to photocopy the log card for future use before filling it out.
                           See Guide Book Pages 13 & 14
     66

-------
WEEKLY WEEKLY WEEKLY WEEKLY

Week
(Date)
1st
nnd
3rd
4*
5th
Weekly Pumping Rate Log Card*
Well Month/Year

Pumping Rate/Flow





Notes or Comments





"Photocopy a log card for each well. Remember to make copies for future use before filling log card out.
                                   See Guide Book Page 14
67

-------
WEEKLY WEEKLY WEEKLY WEEKLY

Week
(Date)
1st
2nd
3rd
4*
5th
Weekly Pumping Rate Log Card*
Well Month/Year

Pumping Rate/Flow





Notes or Comments





"Photocopy a log card for each well. Remember to make copies for future use before filling log card out.
                                   See Guide Book Page 14
68

-------
I WEEKLY
                   WEEKLY
                                               WEEKLY
WEEKLY |
                   Weekly Security Check Log Card*
                          Month/Year
Week
(Date)
1st
2nd
3rd
4*
5th
Are Security
Measures in Good
Condition?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Repairs/Changes





Notes





                                                                     69

-------
I WEEKLY
                     WEEKLY
                                                      WEEKLY
WEEKLY |
                     Weekly Security Check Log Card*
                             Month/Year
Week
(Date)
1st
2nd
3rd
4*
5th
Are Security
Measures in Good
Condition?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Repairs/Changes





Notes





"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 15
     70

-------
I WEEKLY             WEEKLY                       WEEKLY            WEEKLY I







                     Other Notes and Comments
                                                                  71

-------
I WEEKLY             WEEKLY                       WEEKLY            WEEKLY I




                     Other Notes and Comments
                                                                  72

-------
I MONTHLY            MONTHLY                      MONTHLY            MONTHLY I

   Recommended  Monthly Operational Duties

• • Read electric meter at pump house and record.

• • Take appropriate monthly water quality samples.

• • Check and record static and pumping levels of each well.

• • Read all customer meters and compare against total water produced for the month.

• • Inspect well heads.

• • Lubricate locks.

• • Check on-site readings against lab results.

• • Confirm submittal of monthly reports.
                       See Guide Book Pages 17-19                      73

-------
I MONTHLY                MONTHLY                             MONTHLY                MONTHLY I
                           This side intentionally left blank.
                                                                                      74

-------
I MONTHLY
                      MONTHLY
                                                      MONTHLY
                MONTHLY 1
           Monthly Electric Meter Log Card*
Year
Month
(Date)
Jan.

Feb.

March

Electric Meter
Reading






Monthly Water Production
(if pumping is major use of energy)






Notes or Comments






"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 17
                     75

-------
I MONTHLY
                      MONTHLY
                                                      MONTHLY
                MONTHLY 1
           Monthly Electric Meter Log Card*
Year
Month
(Date)
April

May

June

Electric Meter
Reading






Monthly Water Production
(if pumping is major use of energy)






Notes or Comments






"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 17
                     76

-------
I MONTHLY
                      MONTHLY
                                                      MONTHLY
                MONTHLY 1
           Monthly Electric Meter Log Card*
Year
Month
(Date)
July

Aug.

Sept.

Electric Meter
Reading






Monthly Water Production
(if pumping is major use of energy)






Notes or Comments






"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 17
                     11

-------
MONTHLY MONTHLY MONTHLY MONTHLY
Monthly Electric Meter Log Card* Year
Month
(Date)
Oct.

Nov.

Dec.

Electric Meter
Reading






Monthly Water Production
(if pumping is major use of energy)






Notes or Comments






"Remember to photocopy the log card for future use before filling it out.
                                  See Guide Book Page 17
78

-------
I MONTHLY
                     MONTHLY
                                                    MONTHLY
MONTHLY 1
         Monthly Water Quality Sampling Log Card*  Year.
Month
Jan.
Feb.
March
April
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
Take Coliform
Sample (• }












Take Other
Samples (• }












Notes or Comments












"Remember to photocopy the log card for future use before filling it out.
                             See Guide Book Page 17
     79

-------
I MONTHLY
                     MONTHLY
                                                    MONTHLY
MONTHLY 1
         Monthly Water Quality Sampling Log Card*  Year.
Month
Jan.
Feb.
March
April
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
Take Coliform
Sample (• }












Take Other
Samples (• }












Notes or Comments












"Remember to photocopy the log card for future use before filling it out.
                             See Guide Book Page 17
     80

-------
I MONTHLY
                       MONTHLY
                                                         MONTHLY
MONTHLY 1
                 Monthly Static (S) and Pumping (P) Level Log Card*
                              Well            Year
Month
Jan.
Feb.
March
April
May
June
S&P Level
(in ft)
S:
P:
S:
P:
S:
P:
S:
P:
S:
P:
S:
P:
Recharge
Time












Notes or Comments






"Remember to photocopy the log card for future use and for each well before filling it out.
                                See Guide Book Page 18
      81

-------
I MONTHLY
                       MONTHLY
                                                         MONTHLY
MONTHLY 1
              Monthly Static (S) and Pumping (P) Level Log Card cont.*
                              Well            Year
Month
(Date)
July
Aug.
Sept.
Oct.
Nov.
Dec.
S &P Level
(in ft)
S:
P:
S:
P:
S:
P:
S:
P:
S:
P:
S:
P:
Recharge
Time












Notes or Comments






"Remember to photocopy the log card for future use and for each well before filling it out.
                                See Guide Book Page 18
      82

-------
I MONTHLY            MONTHLY                      MONTHLY            MONTHLY I



                    Other Notes and Comments
                                                                  83

-------
I MONTHLY            MONTHLY                      MONTHLY            MONTHLY I



                     Other Notes and Comments
                                                                  84

-------
I MONTHLY          MONTHLY                   MONTHLY          MONTHLY I
  Recommended January Operational  Duties
• •   Overhaul chemical feed pumps (O rings, check valves, and
     diaphragms).
• •   Inspect and clean  chemical feed lines and solution tanks.
• •   Calibrate chemical feed pumps after overhaul.
• •   Begin Safety Equipment Repair Log. Maintain log
     continuously throughout the year.
• •   Operate all valves inside the treatment plant and pump house.
     Maintain log continuously throughout the year.
• •   Review emergency response plans.
                   See Guide Book Pages 20 - 22                  85

-------
I MONTHLY                MONTHLY                             MONTHLY                MONTHLY I
                           This side intentionally left blank.
                                                                                      86

-------
I MONTHLY
                      MONTHLY
                                                        MONTHLY
               MONTHLY 1
            January Task Log Card* Feedpump:
Year
Task
Date Completed
Overhaul chemical feed pumps:
Feeder head cleaned.
O rings and valves checked
for wear.
Worn-out parts replaced
(e.g., diaphragms).
Inspect and clean:
Chemical feed lines.
Solution tanks.
Calibrate chemical feed pumps
after overhaul.







Notes or Comments



"Remember to photocopy the log card for each piece of equipment and for future use before filling it out.
                            See Guide Book Pages 20 & 21
                    87

-------
I MONTHLY             MONTHLY                      MONTHLY            MONTHLY I

               Other Feed Pump Notes or Comments*
 Maintenance Needs:
 Supplier Information:
 Age of Equipment:
 Changes or Repairs:
"Remember to photocopy the log card for each piece of equipment and for future use before filling it out.
                       See Guide Book Pages 20 & 21

-------
I MONTHLY
                     MONTHLY
                                                    MONTHLY
MONTHLY 1
                 Safety Equipment Repair Log*  Year
Date







Equipment:
(SCBA, air monitor,
fire extinguisher, etc.)







Maintenance or
Repair Completed:
(calibrated, cleaned, etc.)







Notes or Comments:







"Remember to photocopy the log card for future use before filling it out.
                             See Guide Book Page 21
     89

-------
I  MONTHLY
                         MONTHLY
                                                               MONTHLY
MONTHLY 1
Date







Equipment:
(SCBA, air monitor,
fire extinguisher, etc.)







Maintenance or
Repair Completed:
(calibrated, cleaned, etc.)







Notes or Comments:







"Remember to photocopy the log card for future use before filling it out.
                                   See Guide Book Page 21
      90

-------
I MONTHLY
                        MONTHLY
                                                            MONTHLY
                            MONTHLY 1
                       Valve Log Card*
Year
When exercising the valves, be sure to record the time, type of valve, if the valve functions properly, and
                                       valve position.
Date











Time











Valve
Number











Location











Type:
(gate,
plug, etc.)











Position: (open
full, open partial,
or closed; # turns)











Comments:
(ok, repairs needed,
will not seat, etc.)











"Remember to photocopy the log card for future use before filling it out.
                                 See Guide Book Page 22
                                  91

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I  MONTHLY
                         MONTHLY
                                                               MONTHLY
MONTHLY 1
Date













Time













Valve
Number













Location













Type:
(gate,
plug, etc.)













Position: (open
full, open partial,
or closed; # turns)













Comments:
(ok, repairs needed,
will not seat, etc.)













"Remember to photocopy the log card for future use before filling it out.
                                   See Guide Book Page 22
      92

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I MONTHLY         MONTHLY                  MONTHLY         MONTHLY I

  Recommended February Operational Duties

• •   Inspect chemical safety equipment and repair or replace as
     needed.

• •   Operate all valves inside the treatment plant and pump house.
                    See Guide Book Page 23                   93

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                                                                                      94

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I MONTHLY
                      MONTHLY
                                                      MONTHLY
MONTHLY 1
                   February Task Log Card*  Year_
Task
Check chemical safety
equipment and repair or replace
as needed.
Operate all valves inside the
treatment plant and pump house.
Date Completed


Number and
Direction of Turns
NotAppJieaUe

Notes or Comments


"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 23
     95

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                      Other Notes or Comments
                                                                   96

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   Recommended March Operational Duties

• •   Inspect, clean, and repair control panels in pump house and
     treatment plant.

• •   Exercise half of all mainline valves.
                    See Guide Book Page 24                  97

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                                                                                      98

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I MONTHLY
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                                                       MONTHLY
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                    March Task Log Card*
Year

Task
Inspect, clean,
and repair
control panels
in pump house
and treatment
plant.
Exercise half
of all mainline
valves.

Date
Completed









Valves
Exercised


Not
Applicable






Condition of
Valves


Not
Applicable





Date
Scheduled
for Repair









Number and Direction of
Turns to Close


Not Applicable





"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 24
                            99

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                      Other Notes or Comments
                                                                  100

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    Recommended April Operational Duties





• •   Inspect and clean chemical feed lines and solution tanks.




• •   Calibrate chemical feed pumps.
                  See Guide Book Pages 25 & 26                101

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                                                                                     102

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I MONTHLY
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                       April Task Log Card*    Year.
Task
Exercise/check all fire hydrant
valves.
Inspect and clean:
Chemical feed lines
Solution tanks
Calibrate chemical feed pumps.
Date Completed





Notes or Comments



"Remember to photocopy the log card for future use before filling it out.
                            See Guide Book Pages 25 & 26
    103

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                      Other Notes or Comments
                                                                  104

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     Recommended May Operational Duties





• •   Inspect storage tanks for defects and sanitary deficiencies.




• •   Clean storage tanks if necessary.
                  See Guide Book Pages 27 & 28                105

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                                                                                     106

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I MONTHLY
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                            May Task Log*  Year_
Task
Date Completed
Inspect Storage Tank #
Check vents and screens.
Check water level measuring
devices."
Check hatch seals/locks."
Check for deterioration.
Inspect Storage Tank #

Check vents and screens.
Check water level measuring
devices .**
Check hatch seals/locks .**
Check for deterioration.
Clean Storage Tanks.










Notes or Comments



"Remember to photocopy the log card for future use and additional tanks before filling it out. "These security checks
should also be conducted daily.
                              See Guide Book Pages 27 & 28                           107

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I MONTHLY            MONTHLY                      MONTHLY             MONTHLY I




                      Other Notes or Comments
                                                                  108

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I MONTHLY          MONTHLY                  MONTHLY          MONTHLY I

    Recommended June Operational Duties

• •   Flush the distribution system and exercise/check all fire
     hydrant valves.

• •   Perform preventive maintenance on treatment plant and pump
     house buildings.
                     See Guide Book Page 29                   109

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I MONTHLY               MONTHLY                            MONTHLY               MONTHLY I
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                                                                                     110

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I MONTHLY
                      MONTHLY
                                                       MONTHLY
MONTHLY 1
                       June Task Log Card*   Year_
Task
Flush the distribution system.
Paint-
Plant piping
Buildings
Tanks
Safely store:
Pipes
Plumbing fittings
Chemicals
Tools
Check fan operation.
Date Completed











Notes or Comments




"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 29
    111

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                      Other Notes or Comments
                                                                  112

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    Recommended July Operational Duties




• •   Inspect and clean chemical feed lines and solution tanks.




• •   Calibrate chemical feed pumps.
                    See Guide Book Page 30                  113

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                                                                                     114

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I MONTHLY
                       MONTHLY
                                                        MONTHLY
MONTHLY 1
                       July Task Log Card*   Year.
Task
Inspect and clean:
Chemical feed lines
Solution tanks
Calibrate chemical feed pumps.
Date Completed




Notes or Comments


"Remember to photocopy the log card for future use before filling it out.
                               See Guide Book Page 30
     115

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                      Other Notes or Comments
                                                                  116

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I MONTHLY         MONTHLY                 MONTHLY         MONTHLY I




  Recommended August Operational Duties





• •   Operate all valves inside the treatment plant and pump house.
                   See Guide Book Page 31                  117

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                                                                                     118

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MONTHLY MONTHLY MONTHLY MONTHLY
August Task Loq Card* Year

Task
Operate all valves inside the
treatment plant and pump
house.
Date Completed



Number and
Direction of Turns



Notes or Comments



"Remember to photocopy the log card for future use before filling it out.
                                  See Guide Book Page 31
119

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                      Other Notes or Comments
                                                                  120

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I MONTHLY          MONTHLY                  MONTHLY           MONTHLY I

Recommended September Operational  Duties


•  •   Exercise mainline valves that were not exercised in March.

•  •   Prepare system for winter operation.
     This task may be postponed until October or November, based on local conditions.

•  •   Make sure unnecessary equipment is properly
     decommissioned.
                     See Guide Book Page 30                    121

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                                                                                     122

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I MONTHLY
                     MONTHLY
                                                     MONTHLY
MONTHLY 1
                   September Task Log Card*  Year.
Task
Exercise mainline
valves that were not
exercised in March.
Date
Completed

Valves
Exercised

Number of
Failures

Date Scheduled Direction and Number of
for Repair Turns to Close

Prepare System for Winter Operation
Task
Check that all exposed
facilities are properly
insulated.
Check that all heaters are
operable.
Check that all vents are
closed.
Date Completed



Notes or Comments



"Remember to photocopy the log card for future use before filling it out.
                             See Guide Book Page 32
    123

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                      Other Notes or Comments
                                                                  124

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  Recommended October Operational Duties





• •   Inspect and clean chemical feed lines and solution tanks.




• •   Calibrate chemical feed pumps.
                   See Guide Book Page 33                 125

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                                                                                     126

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I MONTHLY
                      MONTHLY
                                                      MONTHLY
MONTHLY 1
                     October Task Log Card*  Year.
Task
Inspect and clean:
Chemical feed lines
Solution tanks
Calibrate chemical feed pumps.
Date Completed




Notes or Comments


"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 33
    127

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I MONTHLY            MONTHLY                      MONTHLY             MONTHLY I








                      Other Notes or Comments
                                                                  128

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I MONTHLY         MONTHLY                 MONTHLY         MONTHLY I

 Recommended November Operational Tasks

• •   Prepare system for winter operation if not completed in
     September or October.
                   See Guide Book Page 34                 129

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                                                                                     130

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I MONTHLY
                     MONTHLY
                                                    MONTHLY
MONTHLY 1
                  November Task Log Card*   Year_
Prepare System for Winter Operation
Task
Check that all exposed
facilities are properly
insulated.
Check that all heaters are
operable.
Check that all vents are
closed.
Date Completed



Notes or Comments



"Remember to photocopy the log card for future use before filling it out.
                             See Guide Book Page 34
    131

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                      Other Notes or Comments
                                                                  132

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Recommended December Operational Duties





• •  Contact an electrician to check running amps on well pumps.
                  See Guide Book Page 35                133

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                                                                                     134

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I MONTHLY
                      MONTHLY
                                                      MONTHLY
MONTHLY 1
                   December Task Log Card*   Year_
            Task
                             Date Completed
                                                       Notes or Comments
 Contact an electrician to check
 running amps on well pumps.
"Remember to photocopy the log card for future use before filling it out.
                              See Guide Book Page 35
    135

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I MONTHLY            MONTHLY                      MONTHLY             MONTHLY I




                      Other Notes or Comments
                                                                  136

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MONTHLY MONTHLY MONTHLY MONTHLY
Follow-Up Log Card*
Questions,
Concerns, or
Potential Problems



Date



Lead Person/Action Plan



"Remember to photocopy the log card for future use before filling it out.
                                                                                                   137

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MONTHLY MONTHLY MONTHLY MONTHLY

Questions,
Concerns, or
Potential Problems



Date



Lead Person/Action Plan



"Remember to photocopy the log card for future use before filling it out.
                                                                                                   138

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                         Other Notes or Comments
'Remember to photocopy the log card for future use before filling it out.                             139

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                         Other Notes or Comments
'Remember to photocopy the log card for future use before filling it out.                             140

-------