"Monthly Operating Report Form for Population Less Than or Equal to 3,300" - Mississippi

Monthly Operating Report Form for Population Less Than or Equal to 3,300 is a legal document that was released by the Mississippi Department of Health - a government authority operating within Mississippi.

Form Details:

  • Released on November 5, 2009;
  • The latest edition currently provided by the Mississippi Department of Health;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Mississippi Department of Health.

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Download "Monthly Operating Report Form for Population Less Than or Equal to 3,300" - Mississippi

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MONTHLY OPERATING REPORT for Population =<3,300
Reporting month/year:
Entry point or well number:
Required Minimum Cl (mg/l):
Free Chlorine
concentration
(mg/l) with pump
Date
Time
running
Initials
COMMENTS
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
Was the chlorine residual ever less than the required minimum?
If so, did you monitor every four (4) hours until it was restored?
(Attach grab sample results to this form)
Note: If the chlorine concentration is less than the required minimum for more than 4 hours of well run time, then
it is a Treatment Technique Violation.
Do not submit to MSDH unless requested.
ver. 11/05/2009
MONTHLY OPERATING REPORT for Population =<3,300
Reporting month/year:
Entry point or well number:
Required Minimum Cl (mg/l):
Free Chlorine
concentration
(mg/l) with pump
Date
Time
running
Initials
COMMENTS
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
Was the chlorine residual ever less than the required minimum?
If so, did you monitor every four (4) hours until it was restored?
(Attach grab sample results to this form)
Note: If the chlorine concentration is less than the required minimum for more than 4 hours of well run time, then
it is a Treatment Technique Violation.
Do not submit to MSDH unless requested.
ver. 11/05/2009