Monthly Report Of Operation Of Water Treatment Plant
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Monthly Report Of Operation Of Water Treatment Plant Form. This is a Indiana form and can be use in Department Of Enviromental Management Statewide.
Loading PDF...
Tags: Monthly Report Of Operation Of Water Treatment Plant, 34609, Indiana Statewide, Department Of Enviromental Management
Drinking Water Branch
MC 66-34
100 North Senate Avenue
Indianapolis, IN 46204-2251
(317) 308-3308
American LegalNet, Inc.
www.FormsWorkflow.com
MONTHLY REPORT OF OPERATION
OF WATER TREATMENT PLANT
INDIANA DEPARTMENT OF
ENVIRONMENTAL MANAGEMENT
State Form 34609 (R7 / 9-06)
System Name
PWSID Number
For the Month of
IDEM Field Rep.
Signed
Title
I certify, under penalty of law, by this signature that this document was prepared by me, or under my direction, and
the information submitted is to the best of my knowledge and belief, true, accurate and complete. I am also aware
that there are significant penalties for submitting false information.
Certification Number
PHYSICAL AND CHEMICAL DATA *
Date
Turbidity
Raw
Finished
Alkalinity
Raw
pH
Finished
Raw
Finished
Hardness
Raw
Finish ed
Iron
Raw
Manganese
Finished
Raw
Finished
Phosphate
Fluoride
Finished
Finished
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
* All parameters are to be expressed in mg/1 except pH and turbidity
DUE BY THE 10TH OF THE MONTH FOLLOWING THE REPORTING PERIOD
.
American LegalNet, Inc.
www.FormsWorkflow.com
D ate
W ater
T reated
1000 gal l ons
C hemi cal s U sed -- Pounds
S al t
A l um
L i me
S oda
A sh
C arbon
C hl ori ne
F i l ters
F l uori de
Phosphate
F i l ter R un
( hour s)
G al l ons per
wash x 1000
C hl ori ne R esi dual
Pl ant T ap
F ree
T otal
R emark s
D. S.
F ree
T otal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
M onthl y W ater T reatment
22
T otal G al l ons
23
M ax . D ay
24
M i n. D ay
25
A vg. D ai l y
26
27
28
29
30
31
Part of State Form 34609 (R7/9-06)
Mail to:
Indiana Department of
Environmental Management
Drinking Water Branch, MC 66-34
100 North Senate Avenue
Indianapolis, IN 46204-2251
American LegalNet, Inc.
www.FormsWorkflow.com
