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Monthly Report Of Operation Of Water Treatment Plant 34609 - Indiana
| Monthly Report Of Operation Of Water Treatment Plant Form. This is a Indiana form and can be used in Water Department Of Enviromental Management Statewide . |
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Drinking Water Branch MC 66-34 100 North Senate Avenue Indianapolis, IN 46204-2251 (317) 234-7477 American LegalNet, Inc. www.FormsWorkFlow.com State Form 34609 (R / MONTHLY REPORT OF OPERATION OF WATER TREATMENT PLANT ) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT System Name For the Month of Signed 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. PWSID Number IDEM Field Rep. Title Certification Number PHYSICAL AND CHEMICAL DATA * Date 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 Turbidity Raw Finished Alkalinity Raw Finished Raw pH Finished Hardness Raw Finish ed Iron Raw Finished Manganese Raw Finished Phosphate Finished Fluoride Finished . American LegalNet, Inc. www.FormsWorkFlow.com D ate W ater T reated 1000 gal l ons S al t A l um L i me C hemi cal s U sed -- Pounds S oda A sh C arbon C hl ori ne F l uori de Phosphate F i l ter R un ( hour s) F i l ters G al l ons per wash x 1000 C hl ori ne R esi dual Pl ant T ap F ree T otal D. S. F ree T otal R emark s 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 (R8 Part of State Form 34609 (R8 / 12-12) M onthl y W ater T reatment T otal G al l ons M ax . D ay M i n. D ay A vg. D ai l y 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
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