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Drinking Water Forms & Reporting Formats

 

The forms on this page are for use by public drinking water systems and laboratories.

62-555.900 Forms and Instructions

The forms used by the Department in the Public Water System Supervision Program are adopted and incorporated into the rule that references it. Each form is listed by rule number, which is also the form number, title, and effective date. Please note that rules 62-555.900 (13), (14), and (15), Florida Administrative Code (F.A.C.) have been deleted. In accordance with 62-555.900, F.A.C., persons and public water systems shall report to the Department using the forms listed below or using computer-generated versions of the forms listed below provided such versions are identical to the forms listed below in every respect other than the font type and style, font size, and character spacing.

Rule
Number
Title Effective Date  Available
Formats
62-555.900(1) Application for a Specific Permit to Construct PWS Components 8/28/03 PDF | Word
62-555.900(2) Monthly Operation Report for Subpart H Systems 10/14/04 Excel
62-555.900(3) Monthly Operation Report for PWSs Treating Raw Ground Water or Purchased Finished Water 8/28/03 PDF | Word 2003 | Word 2007
62-555.900(4) Monthly Operation Report for Consecutive Systems that Do Not Treat Water 8/28/03 PDF | Word
62-555.900(5) Monthly Operation Report for PWSs Fluoridating Water 8/28/03 PDF | Word2003 | Word2007
62-555.900(6) Monthly Operation Report for Consecutive Systems that Receive Purchased Finished Water from a Subpart H System 4/03/03 PDF | Word
62-555.900(7) Notice of Intent to Use the General Permit for Construction of Water Main Extensions for PWSs 8/28/03 PDF | Word
62-555.900(8) Application for Transfer of a PWS Construction Permit 8/28/03 PDF | Word
62-555.900(9) Certification of Construction Completion and Request for Clearance to Place Permitted PWS Components into Operation 8/28/03 PDF | Word
62-555.900(10) Asbestos-Free Certification or Asbestos Sampling Plan for PWSs 8/28/03 PDF | Word
62-555.900(11) Monthly Operation Report for Summation of Finished-Water Production by CWSs that Have Multiple Treatment Plants 8/28/03 PDF | Word 2003 | Word 2007
62-555.900(12) PWS Sampling Plan for Lead and Copper Tap Samples and Water Quality Parameters 8/28/03 PDF | Word
62-555.900(16)

Interim

PWS Certification of Notification of Lead and Copper Tap Sample Results Pending PDF | Word
62-555.900(17) Lead Public Education Program Report for PWSs 10/01/10 PDF | Word
62-555.900(18)

Interim

Notice of Intent to Use the General Permit for Construction of Lead or Copper Corrosion Control, or Iron or Manganese Sequestration, Treatment Facilities for Small or Medium PWSs Pending PDF | Word
62-555.900(19) Certification of Delivery of Consumer Confidence Report 4/10/03 PDF | Word
62-555.900(19)
Alternate
Certification of Delivery of Consumer Confidence Report 1/13/13 FWRA Website
62-555.900(20) New Water System Capacity Development Financial and Managerial Operations Plan 8/28/03 PDF | Word
62-555.900(20)
Alternate
New! New Water System Capacity Development Financial and Managerial Operations Plan 8/28/03 PDF | Word
62-555.900(21) Certification of Delivery of Consumer Confidence Information to Supplied Systems 4/10/03 PDF | Word
62-555.900(22) Certification of Delivery of Public Notice 1/17/05 PDF | Word
62-560.545(2) Reduced Monitoring Application Questionnaire for Synthetic Organic Contaminants N/A PDF | Word

Laboratory Reporting Formats

Analytical results for samples taken pursuant to Chapter 62-550, Florida Administrative Code, shall be reported by the laboratory in a format which includes all of the required information described in the documents provided below. Laboratories may use computer generated versions of the formats provided such versions are identical in every respect other than print size, type, and spacing. If laboratory analysis reports are submitted without all of the required information, as set forth below, the submittal will be rejected. (Reference Rule 62-550.730, Florida Administrative Code)

Reporting Format Rule Reference File Format
62-550.730: Format to be used for reporting all drinking water chemical analysis results except for lead and copper tap samples and water quality parameter samples. PDF | Word
62-550.730: Format to be used for reporting all drinking water bacteriological analysis results. PDF | Word
62-550.730(4)(a): Lead and copper tap samples taken from the interior taps of private residences. PDF | Word
62-550.730(4)(c): Water quality parameter samples taken from the entry point to the distribution system and at points within the distribution system. PDF | Word
Interagency Transfer of a Public Water System (This Form is for internal use of the Department of Environmental Protection and the Department of Health.) PDF

Example Stage 1 D/DBPR Reporting Formats

The following example reporting formats were developed to assist PWSs in reporting parameters for the Stage 1 Disinfectants/Disinfection Byproducts Rule(D/DBPR).  PWSs are not required to use the example reporting formats. PWSs can use any format they wish as long as the information required by 62-550.821(12), F.A.C. is provided.

Example Reporting Formats File Format
Disinfectant Residual (Chlorine or Chloramines) PDF | Word
Disinfection Byproducts (Total Trihalomethanes (TTHMs) and Haloacetic Acids Five (HAA5s) PDF | Word

Example Stage 2 D/DBPR Reporting Format

The following example reporting format was developed to assist PWSs in reporting parameters for the Stage 2 Disinfectants/Disinfection Byproducts Rule (D/DBPR). PWSs are not required to use the example reporting format. PWSs can use any format they wish as long as the information required by 40 CFR 141.629(a) is provided.

Example Reporting Format File Format
Disinfection Byproducts (Total Trihalomethanes (TTHMs) and Haloacetic Acids Five (HAA5s) PDF | Word

Example Stage 1 D/DBPR and Stage 2 D/DBPR Monitoring Plan Format

Stage 1 D/DBPR: The following example monitoring plan format was developed to assist PWSs in preparing a Stage 1 Disinfectants/Disinfection Byproducts Rule (D/DBPR) monitoring plan. PWSs are not required to use the example monitoring plan format. PWSs can use any format they wish as long as the information required by 62-550.821(11), F.A.C., is provided.

Stage 2 D/DBPR: The following format was developed to assist PWSs in preparing a Stage 2 Disinfectants/Disinfection Byproducts Rule (D/DBPR) monitoring plan. PWSs are not required to use this example monitoring plan format. PWSs can use any format they wish as long as the information required by the applicable federal regulations (40 CFR 141.622(a)(1)) is provided.

Example Monitoring Plan Format Format
Stage 1 D/DBPR Monitoring Plan Example PDF | Word
Stage 2 D/DBPR Monitoring Plan Format PDF | Word

 

Example Operational Evaluation Level Reporting Format Format
Operational Evaluation Level Reporting Format PDF | Word

 

Last updated: September 30, 2014

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