Form MO780-1904 "Disinfection and Turbidity Report for Surface Water Systems 10,000 Population" - Missouri

What Is Form MO780-1904?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2013;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MO780-1904 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-1904 "Disinfection and Turbidity Report for Surface Water Systems 10,000 Population" - Missouri

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
WATER PROTECTION PROGRAM – PUBLIC DRINKING WATER BRANCH
DISINFECTION AND TURBIDITY REPORT FOR SURFACE WATER
SYSTEMS < 10,000 POPULATION
PWS ID
MONTH
PWS NAME
MO
ADDRESS
TELEPHONE NUMBER WITH AREA CODE
YEAR
CITY
ZIP CODE
COUNTY
PLANT
SEE INSTRUCTIONS
DISTRIBUTION DISINFECTION
TURBIDITY
1. Number of samples analyzed, A: ______
1. Total number measurements taken monthly, A: ______
2. Number of samples below 0.2 mg/L, B: ______
2. Number of measurements below 0.3 NTU, B: ______
[(A-B)/A] x 100 = C: ______ % meeting minimum disinfection required.
[B/A] x 100 = C: ______ % meeting turbidity requirements.
3. Avg. disinfectant residual for the month _______ mg/l
Lowest disinfectant at
Duration
Value of turbidity
entrance to distribution
Highest turbidity
disinfectant fell
measurements that
Hours of
Finished water
Date
system (mg/L)
measurement of
below 0.5 mg/L
exceed
operation
temperature (C)
Free Chlorine
the day
free Cl
or 1 mg/L
2
Chloramines
chloramines
1NTU
5 NTU
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
NAME OF PERSON PREPARING REPORT
SIGNATURE OF RESPONSIBLE OFFICIAL
DATE
MO 780-1904 (07-13)
MISSOURI DEPARTMENT OF NATURAL RESOURCES
WATER PROTECTION PROGRAM – PUBLIC DRINKING WATER BRANCH
DISINFECTION AND TURBIDITY REPORT FOR SURFACE WATER
SYSTEMS < 10,000 POPULATION
PWS ID
MONTH
PWS NAME
MO
ADDRESS
TELEPHONE NUMBER WITH AREA CODE
YEAR
CITY
ZIP CODE
COUNTY
PLANT
SEE INSTRUCTIONS
DISTRIBUTION DISINFECTION
TURBIDITY
1. Number of samples analyzed, A: ______
1. Total number measurements taken monthly, A: ______
2. Number of samples below 0.2 mg/L, B: ______
2. Number of measurements below 0.3 NTU, B: ______
[(A-B)/A] x 100 = C: ______ % meeting minimum disinfection required.
[B/A] x 100 = C: ______ % meeting turbidity requirements.
3. Avg. disinfectant residual for the month _______ mg/l
Lowest disinfectant at
Duration
Value of turbidity
entrance to distribution
Highest turbidity
disinfectant fell
measurements that
Hours of
Finished water
Date
system (mg/L)
measurement of
below 0.5 mg/L
exceed
operation
temperature (C)
Free Chlorine
the day
free Cl
or 1 mg/L
2
Chloramines
chloramines
1NTU
5 NTU
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
NAME OF PERSON PREPARING REPORT
SIGNATURE OF RESPONSIBLE OFFICIAL
DATE
MO 780-1904 (07-13)
INSTRUCTIONS: DISINFECTION AND TURBIDITY REPORT FOR SURFACE WATER
SYSTEMS <10,000 POPULATION
Please fill out information completely and legibly.
Distribution Disinfection
1. On line 1, enter the total number of samples from the distribution system analyzed for residual disinfectant concentration (total
chlorine or combined chlorine) during the month. The residual disinfectant concentration measurements must be taken at the same time
and location as your routine monthly coliform samples. This is the value for A.
2. On line 2, enter the number of samples for the distribution systems that had less than 0.2 mg/L residual disinfectant concentration.
This is the value for B.
3. Subtract B, from A. (A-B). Divide that number by A. Then multiply by 100. This will give you the value for C. For example: if A= 20
and B= 3, then C= [(20-3)/20] x 100 = 85%
4. On line 3, enter the arithmetic average for all residual disinfectant samples taken during the month.
Turbidity:
1 On line 1, enter the total number of combined filter turbidity measurements taken during the month. This is the value for A.
2 On line 2, enter the number of combined filter turbidity measurements taken during the month, which are less than or equal to 0.3
NTU.
This is the value for B.
3 Divide B. by A. (B/A). Then multiply that number by 100. This will give you the value for C. For example: if A = 120 and B = 117, then
C= (117/120) x 100 = 97.5%
Hours of operation:
For each day, record the number of hours each water treatment plant was in operation.
Finished Water Temperature
For each day, record the temperature of water entering the distribution.
Lowest Residual Disinfectant at Entrance to Distribution System:
For each day, record the lowest measurement of residual disinfectant concentration (mg/L) in water entering the distribution system
(free available chlorine or chloramines).
Duration Residual Disinfectant Fell Below Requirement:
For each day, record the duration (hours, tenths) of each period (if any) when the residual disinfectant concentration in water entering
the distribution system fell below 0.5 mg/L free chlorine or 1 mg/L chloramines. Note: should this occur the public water system must
notify the department as soon as possible, but no later than by the end of the next business day.
The Highest Turbidity Reading for the Day:
For each day, record the highest turbidity reading on the combined plant effluent during the plants operational period.
Value of Turbidity Measurements that exceed 1 NTU and 5 NTU:
For each day, record the value of any turbidity measurements taken during the month, which exceed 1 NTU and 5 NTU. Note: should
this occur the public water system must notify the department as soon as possible, but no later than the end of the next business day.
INDIVIDUAL FILTER MONITORING AND REPORTING
1 Was each filter continuously monitored for turbidity and results recorded every 15 minutes? __________
2 Was there a failure of the continuous turbidity monitoring equipment? ____________
If yes on 2, was the equipment repaired within 5 working days or 14 days with department approval?_____________
If yes on 2, was grab sampling done every four hours until failure corrected?______________
3 Was any individual filter turbidity level >1.0 NTU in two consecutive measurements taken 15 minutes apart? ____________
If yes, perform follow-up actions step 1.
4 Was any individual filter level for three months in a row > 1.0 NTU in two consecutive recordings taken 15 minutes apart? ________
If YES, perform follow-up actions step 2
5 Was any individual filter turbidity level > 2.0 NTU in two consecutive recordings taken 15 minutes apart for two consecutive
months?_______
If YES, perform follow-up actions step 3
FOLLOW-UP ACTIONS to PERFORM
1. Report filter numbers, turbidity measurements that exceed 1 NTU and dates the exceedances occurred and causes if known.
2. Conduct a self-assessment of the filters within 14 days of the triggering event. The system must report the date self-assessment was
triggered and the date it was completed.
3. The system must arrange to have a comprehensive performance evaluation performed not later than 60 days following the triggering
event. The evaluation must be completed and submitted to the department within 120 days following the triggering event.
The Missouri Department of Natural Resources-Public Drinking Water Branch recommends contacting your local regional
office if any individual filter exceeds 1.0 NTU, the lowest trigger in the individual filter standards.
MO 780-1904 (07-13)
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