|
|
| 331-291 -
Water System Adequacy Request Form - Southwest Regional
Office |
(Word) (PDF) |
| 331-293 - Water System
Adequacy Request Form - Eastern Regional Office |
(Word) (PDF) |
| 331-321 - Adequacy Request Form - Lending Institutions and
Realtors |
(Word) (PDF) |
|
|
| 331-203
- Consumer Confidence Report Certification Form |
(Word)
(PDF) |
|
|
| 331-439 - Contract Operator Public Listing
Form |
(Word) (PDF) |
|
|
| 331-154 - Cross-Connection Control Program Summary
Report for 2011 |
(Word) |
| 331-155 - Public Water System Cross-Connection Control
Activities Annual Summary Report for 2011 |
(Word) |
| 331-156 - Exceptions to High-Health Hazard Premises
Isolation Requirements for 2011 Annual Summary Report |
(Word) |
| 331-434 - Cross-Connection Control Severe Health Hazard
Facility Report for 2011 |
(Word) |
| 331-457 - Cross-Connection Control Program Backflow
Incident Report |
(Word) |
| Back to top |
|
|
|
331-201 - 2012 Drinking Water
State Revolving Fund Application Form |
Online
form |
|
If you cannot complete the
online form,
here are the Word forms: |
DWSRF Application
EZ-1 /
EZ-2
Supplemental Financial
Information |
|
|
| 331-121 -
Construction Completion Report |
(Word)
(PDF) |
| 331-122
- Engineering Design Review Report (For Distribution-Related Project
Submittal Exceptions) |
(Word)
(PDF) |
| 331-146 -
Construction Completion Report Form for Submittal Exception Process
|
(Word) (PDF) |
| 331-147 -
Construction Completion Report Form for Distribution Main Projects
|
(Word) (PDF) |
| 331-149 -
Project Approval Application, WA State Dept. of Health
|
(Word) (PDF) |
| 331-396 - Small Water System Management Program
Submittal |
(Word)
(PDF) |
| 331-397 - Water System Plan Submittal |
(Word)
(PDF) |
|
Water
Rights
Self Assessment |
|
|
Instructions for Completing the
Water Rights Self Assessment Forms |
(Word) (PDF) |
|
331-370 - Project Report
Form - Water Rights Self Assessment
|
(Word) (PDF) |
|
331-371 - Water System Plan - Water Rights Self Assessment -
Existing Status |
(Word)
(PDF) |
|
331-372 - Water System Plan - Water Rights Self
Assessment--6 Year Forecast |
(Word)
(PDF) |
|
331-373
- Water System Plan - Water Rights Self Assessment--20 Year
Forecast |
(Word)
(PDF) |
| Back to top |
|
|
| 331-189 - Potential GWI Source Identification and
Designation |
(Word) (PDF) |
| 331-190
- GWI Determination Process Purveyor's Choice |
(Word) (PDF) |
| 331-191 - GWI Quality Monitoring Interview Documentation |
(Word) (PDF) |
| 331-192 - GWI Water Quality Monitoring Confirmation |
(Word) (PDF) |
| 331-193 - GWI Water Quality Monitoring Report Form |
(Word) (PDF) |
| 331-194 - GWI Hydraulic Connectivity Determination,
Analysis of Water Quality Monitoring Data |
(Word) (PDF) |
| 331-195 - GWI Hydraulic Connectivity Determination,
Descriptive Statistics |
(Word) (PDF) |
|
|
| 331-163 - Coliform Major Monitoring Violation Public
Notice |
(Word) (PDF) |
| 331-248 - Public Notice Certification Form Nitrate MCL
Violation |
(Word)
(PDF) |
| 331-263 - Coliform Maximum Contaminant Level Exceeded:
Non-Acute MCL |
(Word) (PDF) |
| 331-264 - Public Notice Certification Acute Coliform MCL |
(Word) (PDF) |
| 331-354 - Lead and Copper Initial Monitoring Violation |
(Word)
(PDF) |
| 331-357 -
Notice to Water System Users: Annual Nitrate Monitoring
Violation |
(Word)
(PDF) |
| 331-360 - Disinfection Byproducts Monitoring Violation
|
(Word) (PDF) |
| 331-360 Spanish - Disinfection Byproducts Monitoring Violation
|
(Word) (PDF) |
| 331-394 - Monthly Bromate Monitoring Violation |
(Word)
(PDF) |
| 331-395 - Quarterly Total Trihalomethane (TTHM)/Haloacetic
Acids (HAA5) Monitoring Violation |
(Word) (PDF) |
| 331-412 - Quarterly Nitrate Monitoring Violation Form |
(Word) (PDF) |
| 331-416 - Notice to Water System Users: Reliably and
Consistently Under the Maximum Contaminant Level - Annual
Nitrate Monitoring Violation Form |
(Word) (PDF) |
| 331-461 - Lead and Copper Monitoring Violation - English
and Spanish |
(Word) (PDF) |
| 331-462 - Lead and Copper Consumer Notice Requirements and Certification |
(Word)
(PDF) |
| Back to top |
|
Surface Water Treatment Forms
You will need Microsoft Excel 97 or a later
version on your computer to use these forms.
|
|
Excel file includes CT look up
table. The three forms below (DOH 331-023, 331-048
& 331-172) are contained in one Excel workbook file. After opening
the file, note the four tabs at the bottom. The first tab (Cover
Page and Notes) contains the directions on use of the forms. Open
and read it first. Then click on the other tabs to access the
forms.
331-023 - Water Treatment Plant Monthly Report
331-048 - SWTR Disinfection
Monthly Report
331-172 - Surface Water Treatment
Plant Monthly Report Summary
Open the Excel Workbook
(507 KB) and view the directions (Cover Page and Notes) and
forms above.
|
Water Quality
|
|
Coliform |
331-319F - Coliform Bacteria Analysis Form
Note: Regular size form 11 in x 4 in. |
(Word) |
331-320F - Coliform Bacteria Analysis Form
Note: Same form as 331-319-F but 5 in. x 8 in. and designed
to fit into a window envelope. |
(Word) |
Completing the above forms:
- Save the templates to your computer.
- Text in "Red" can be deleted so you can add your
name, address, and your Ecology-accredited Method Code.
Printing the form: The forms are designed to print
100%. Page scaling options are available by selecting "file"
and then "print." |
| E. coli - Fecal Coliform Community Drinking Water
Warning notice |
(Word)
(PDF) |
| E. coli - Fecal Coliform Non-community Drinking Water
Warning notice |
(Word)
(PDF) |
|
Disinfection Byproducts |
| 331-341 - Disinfection Byproduct Monitoring Plan |
(Excel) |
| 331-464 - Stage 2 Disinfection Byproducts Monitoring
Plan |
(Excel) |
| The two organizations below can help you
complete these forms.
|
|
Epichlorohydrin and
Acrylamide |
| 331-337 - Certification
Form of Epichlorohydrin and Acrylamide Usage |
(Word) |
|
|
| Annual Water
Use Efficiency Performance Report -
Click for new online reporting form |
