Inspect the treatment facility. Are there: Procedures in place for proper operation and maintenance? Yes No Yes No Is the treatment system operating properly? Yes No Yes No Changes in equipment or process? Describe. Yes No Yes No Yes No Yes No Evidence of vandalism or other security breaches? Source Are there procedures in place for periodic inspection and maintenance of Yes No Yes No the source facilities? Does each source have a raw water sample tap properly located? Yes No Yes No Inspect the source facilities. Is the: Yes No Yes No Sanitary control area free of all potential sources of contamination? Wellhead or spring box above grade with no potential for flooding? Yes No Yes No Well cap sealed and watertight? Well casing free of unprotected openings? Yes No Yes No Pressure tank waterlogged? Yes No Yes No Spring box (structure, hatch, and overflow) free of any unprotected Yes No Yes No openings? Yes No Yes No Other: Have there been any changes in condition or operation? Yes No Yes No Other assessment activities. Describe:
Inspect the treatment facility. Are there: Procedures in place for proper operation and maintenance? Is the treatment system operating properly? Changes in equipment or process? Describe. Evidence of vandalism or other security breaches? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Source Are there procedures in place for periodic inspection and maintenance of the source facilities? Yes No Yes No Does each source have a raw water sample tap properly located? Yes No Yes No Inspect the source facilities. Is the: Sanitary control area free of all potential sources of contamination? Wellhead or spring box above grade with no potential for flooding? Well cap sealed and watertight? Well casing free of unprotected openings? Pressure tank waterlogged? Spring box (structure, hatch, and overflow) free of any unprotected openings? Other: Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Have there been any changes in condition or operation? Yes No Yes No Other assessment activities. Describe: