Exhibit 05 - Turb CT - TLRS.pdf

OHA - Drinking Water Program - Turbidity Monitoring Report Form ' County: Douglas Conventional or Direct Filtration

System Name: USFS TILLER RANGER STATION 10 #: OR4101092 WTP-:WTP-A MonthlYear:

12 AM 4AM 8AM NOON 4 PM 8 PM

Highest Reading of

DAY 1

[NTUj [NTUj [NTUj [NTUj [NTUj [NTUj the Day

[NTUj

I I 27

30 - 31 , Conventional or Direct Filtration Monthly Summary (Answer Yes or No)

95% of the 4-hour turbidity readings $ 0.3 NTU? Yes I No CT's met everyday?

All CI2 residuals at entry point ~ 0.2 mgtl? All the 4-hour turbidity readings $ 1 NTU? Yes I No (see back)

All turbidity readings < IFE2 triggers? Yes I No 2 Yes I No Yes I No

Notes:

PRINTED NAME:

I SIGNATURE: I DATE:

PHONE #: ( ) CERT#:

.. r " " Including continuous turbidity data, If applicable, for optimization recording purposes. vompliance values In columns 12 AM through "8 PM" may not correspond to continuous readings' maximum. 2 IFE = Individ. Filter Eff!. (OAR 333-061 -0040(1)(e)(B&C))

OHA - Drinking Water Program - Surface Water Quality Data Form

I USFS TILLER RANGER STATION 10 #: OR4101092 WTP-: WTP-AMonthNear: Required Log Inactivation:

Date / Minimum CI2 Contact

Actual Required Peak Hourly

Residual at Time Temp pH CT Met? 3 Demand Time 1st User (e)3 ( T )

CT CT Flow

[ppm .or mg/L) [minutes) eXT [0 C) Use Yes / No [GPM) tables

1 /

2/

3/

4/

5 /

6/

7/

8/

9/

10/

11 /

12/

13/

14/

15/

16/

17 /

18/

19/

20/ ----1.

21 /

22/

23/

24/

25/

26/

27/

28/

29/

30/

31 / ~ If CI2 at entry POint' < 0.2 mgll; OR CT not met, notify DWP by end of next business day.

Download form at: www.public.health .oregon.gov/HealthyEnvironments/DrinkingWater/MonitoringiDocuments/turb-conv-direct.pdf

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