Drinking Water

• Annual Fee Inventory Update Form Annual Fee Inventory Update Form     
• Inactivation Form
• Inventory Update Form                  
• Population Certification Statement Form Population Certification Statement Form
• Drinking Water Contact Update Form     
   

• Consumer Confidence Report Certificate of Delivery
• Consumer Confidence Report Portrait Template
• Consumer Confidence Report Landscape Template

Disinfectant and Disinfection By-products Rule

• D/DBP request for reduced monitoring form
• Violation Notification Report Form  (for reporting violation of the DDBP Rule)

Disinfectant and Disinfection Byproducts Forms

• DBP form 3 - TTHM and HAA5 quarterly report worksheet
• DBP form 4 - Running annual average reporting form
• DBP form 6 - Quarterly reporting form for running annual average for bromate
• DBP form 7 - Quarterly report for daily, monthly and additional chlorite monitoring
• Stage 2 Locational Running Annual Average Form

Maximum Residual Disinfectant Level Reporting Forms

• MRDL Form 3 - Quarterly Report for Daily and Monthly Chlorine Dioxide  

Disinfection Byproduct Precursors Reporting Forms

• DDBP precursor form 2 - Alternative compliance criteria for enhanced coagulation treatment plants  
• DDBP precursor form 3 - Alternative compliance criteria for enhanced softening treatment plants  
• DDBP precursor form 4 - Actual removal ratios for enhanced coagulation and softening treatment plants

• Positive Total Coliform Investigation Form
• 4 Log Inactivation of Viruses Certification Form
• Groundwater Entry Point Chlorine Residual Disinfectant Monitoring Log
• Groundwater Entry Point Chlorine Residual Disinfectant Monitoring Log

• Glyphosate monitoring waiver request form

Disinfection Byproduct

• Form #1 - Total Trihalomethanes - TTHM Analysis Laboratory Report Form
• Form #2 - Haloacetic Acid HAA5 Analysis Laboratory Report Form
• Form #5 - Bromate and/or Chlorite Analysis Laboratory Reporting Form

Disinfection Byproduct Precursors 

• Form #1 - Disinfection Byproduct Precursor

Inorganic/Organic Chemical and Radionuclide

• Inorganic Chemicals - Except Nitrate and Nitrite
• Nitrate and Nitrite Certified Laboratory Report Form
  • Definitions for Nitrate and Nitrite Lab Reporting
• Organic Chemicals Rule
• Radionuclides

Lead and Copper

• Definitions for Lead and Copper Forms and Templates
• Lead and Copper Certified Laboratory Report Form
• Water Quality Parameter Results Report Form

Surface Water Treatment

• Microscopic Particulate Analysis (MPA)
• Long Term 2 E. Coli Laboratory Reporting Form

Total Coliform

• Form 1 - Routine Safe Data Summary
• Form 2 - Unsafe Routine Sample Data and Repeats
• Individual Bacteriological Sample Data

• Instructions
  • Definitions for Lead and Copper Forms and Templates
• Sample Site Location
  • Sample Site Pool Location Details Form
  • Sample Site Location Change Form
  • Community Materials Survey Sample Pool Summary Form
  • Non-Transient, Non-Community Materials Survey Sample Pool Summary Form
• Sample Collection and Results Submission
  • Homeowner Certification Form
  • Lead and Copper Sample Collection Instructions
  • Sample Results, Collection Certification, and 90th Percentile Form
  • Water Quality Parameter Results Report Form
• Action Level Exceedance
  • Lead Public Education Certificate of Delivery Form

The following Word and PDF templates may be downloaded, saved to your computer, and populated with your system specific information.  Please be sure you have the most recent version of the free Adobe Reader. To narrow your search please select from the following. If unsure of your PWS classification, please check your monitoring schedule for Federal System Type and State Source Type.

1. Inventory and Rule Sampling Plan Sections Only
2. Ground Water Systems
3. Surface Water Systems
4. Purchased, Approved Integrated, and Water Hauler Systems

Inventory and Rule Sampling Plan Sections Only

• Inventory Update Form
• Rule Sampling Monitoring Plan
• Rule Sampling Monitoring Plan

Ground Water Systems

• Community Groundwater System Monitoring Plan
• Community Groundwater System Monitoring Plan
• Non-Transient Non-Community Groundwater System Monitoring Plan  
• Non-Transient Non-Community Groundwater System Monitoring Plan  
• Transient Non-Community Ground Water System Monitoring Plan  
• Transient Non-Community Ground Water System Monitoring Plan  

Surface Water Systems

• Community Surface Water and GWUDI System Monitoring Plan
• Community Surface Water and GWUDI System Monitoring Plan  
• Non-Transient Non-Community Surface Water and GWUDI System Monitoring Plan
• Non-Transient Non-Community Surface Water and GWUDI System Monitoring Plan
• Transient Non-Community Surface Water and GWUDI System Monitoring Plan
• Transient Non-Community Surface Water and GWUDI System Monitoring Plan

Purchased, Approved Integrated, and Water Haluer Systems

• Purchased
  • Community or Non-Transient Non Community Purchase System Monitoring Plan
  • Community or Non-Transient Non Community Purchase System Monitoring Plan
  • Transient Non-Community Purchase System Monitoring Plan  
  • Transient Non-Community Purchase System Monitoring Plan      
• Approved Integrated
  • Community or Non-Transient Non Community Integrated System Monitoring Plan
  • Community or Non-Transient Non Community Integrated System Monitoring Plan
• Water Hauler
  • Water Hauler System Monitoring Plan
  • Water Hauler System Monitoring Plan

Publication Notification Rule

• Public notification guidance March 2003
• Public notice 10 required elements
• Translated phrases
• Waiver of disinfection certificate

Tier 1 Forms

• Tier 1 Certificate of Delivery Form
• Tier 1 Instructions

Tier 1 Templates

• Boil water advisory for E. coli or fecal bacteria
• Boil water advisory for E. coli or fecal bacteria in Spanish
• Bottled water advisory
• Bottled water advisory in Spanish
• Chlorine dioxide MRDL violation in distribution system
• Delayed repeats after E. coli or fecal positive sample
• Loss of pressure boil water advisory
• Loss of pressure bottled water advisory
• Nitrate MCL bottled water advisory
• Nitrate MCL bottled water advisory in Spanish
• Tampering or security breech notice
• Turbidity MCL public notice advisory for conventional, direct, or membrane filtration plants
• Turbidity MCL public notice advisory for slow sand, diatomaceous earth, bag, or cartridge filtration plants
• Unapproved source boil water advisory

Public Notification Rule

• Public notification guidance March 2003
• Public notice 10 required elements
• Translated phrases
• Waiver of disinfection certificate

Tier 2 Required Forms

• Tier 2 Certificate of Delivery Form  
• Tier 2 Instructions

Tier 2 Templates

• Arsenic MCL violation
• Bromate MCL violation
• Disinfectant residual below minimum in a monthly occurrence
• Disinfectant residual below minimum in a single occurrence
• Failure to filter surface water (SW) or ground water under direct influence (GWUDI)
• Failure to install corrosion control after exceeding lead action level
• Failure to provide disinfectant contact time
• Fluoride MCL violation
• Haloacetic acids MCL violation
• Other MCL violation
• Radionuclide MCL violation
• Total organic carbon treatment technique using alternative compliance criteria
• Total organic carbon treatment technique using removal ratio
• Total trihalomethanes MCL violation
• TTHM HAA5 MCL violation
• Turbidity 95% and CI2 single occurrence violation for slow sand, DE, bag, cartridge filtration plants
• Turbidity MCL public notice advisory for conventional, direct, or membrane filtration plants
• Turbidity MCL public notice advisory for slow sand, diatomaceous earth, bag, or cartridge filtration plants

Tier 3 Required Forms

• Tier 3 Certificate of Delivery Form
• Tier 3 Instructions

Tier 3 Templates

• Monitoring and Reporting Violation
• Fluoride Secondary MCL Exceedence
• Total coliform failure to collect repeat samples

Problems Corrected Notice

• Instructions for problem corrected notice
• Problem corrected notice template   

Monthly Operating Reports (MOR)

For turbidity and entry point disinfectant reporting download the instructions and the form for the filtration type used by your water treatment plant.

• New Form Instructions
• Conventional and Direct Filtration Form
• Membrane Filtration Form
• Slow Sand, Diatomaceous Earth and Other Filtration Form

Long term 2 enhanced surface water treatment rule templates

• Bin Classification Report Form
• Intent to grandfather
• Intent to provide maximum treatment