Example Coliform Monitoring Plan Coliform Monitoring Plan for: XYZ Water Association_ System Information Plan Date: 4/5/16 Water System Name County System I.D. Number XYZ Water System Spokane XXXXXA Name of Plan Preparer Position Daytime Phone # Johnny Spokane Operator 509-111-2222 #S01 - Well 1, 225 ft, Sources: DOH Source Number, Source #S02 - Well 2, 175 ft, 90gpm Name, Well Depth, Pumping Capacity #S03 - Spring, 150gpm X Tank - 200,000 gallon tank Storage: List and Describe 2. Y, Z Tank - 500,000 gallon tank Treatment Plant 001 S01 Chlorination w/o 4-log virus – Treatment: Source Number & Process treatment Treatment 002 S02 Chlorination w/o 4-log virus – treatment Treatment Plant 003 S03 Chlorination w/4-log virus – treatment not conducting Compliance Monitoring – X Upper Zone – Pressure Zones: Number and name Y Z Pressure Zone X 750 people – Population by Pressure Zone Pressure Zone Y 1,250 people – Pressure Zone Z 550 people – Number of Routine Samples Required Number of Sample Sites Needed to Represent the Monthly by Regulation: 3 Distribution System: 4 DOH Approval of Triggered *Request Yes No Source Monitoring Plan? *If approval is requested a fee will be charged for the review. Laboratory Information Laboratory Name Office Phone # You Betcha Laboratory (509) 111-2222 Address After Hours # Close Enough Road (800) 111-2222 Spokane, WA 99204 Hours of Operation Monday Friday 8 a.m. to 5 p.m., Weekends on request only –
Example Coliform Monitoring Plan Coliform Monitoring Plan for: XYZ Water Association_ System Information Plan Date: 4/5/16 Water System Name XYZ Water System County Spokane System I.D. Number XXXXXA Name of Plan Preparer Johnny Spokane Position Operator Daytime Phone # 509-111-2222 Sources: DOH Source Number, Source Name, Well Depth, Pumping Capacity #S01 - Well 1, 225 ft, #S02 - Well 2, 175 ft, 90gpm #S03 - Spring, 150gpm Storage: List and Describe X Tank - 200,000 gallon tank 2. Y, Z Tank - 500,000 gallon tank Treatment: Source Number & Process Treatment Plant 001 – S01 Chlorination w/o 4-log virus treatment Treatment 002 – S02 Chlorination w/o 4-log virus treatment Treatment Plant 003 – S03 Chlorination w/4-log virus treatment – not conducting Compliance Monitoring Pressure Zones: Number and name X – Upper Zone Y Z Population by Pressure Zone Pressure Zone X – 750 people Pressure Zone Y – 1,250 people Pressure Zone Z – 550 people Number of Routine Samples Required Monthly by Regulation: 3 Number of Sample Sites Needed to Represent the Distribution System: 4 *Request DOH Approval of Triggered Source Monitoring Plan? Yes No *If approval is requested a fee will be charged for the review. Laboratory Information Laboratory Name You Betcha Laboratory Office Phone # (509) 111-2222 Address Close Enough Road Spokane, WA 99204 After Hours # (800) 111-2222 Hours of Operation Monday – Friday 8 a.m. to 5 p.m., Weekends on request only
XYZWaterAssociation.docx