Attachment_20_Sample_ADEQ_Potable_Water_Inspection_Report__16_pages.pdf

Attachment (20): Sample ADEQ Potable Water Inspection Report

Rev. 190826

ARIZONA DEPARTMENT OF ENVIRONMENTAL QUALITY

NOTICE OF INSPECTION RIGHTS

FACILITY INFORMATION ADEQ INFORMATION

Facility Name (Customer): Yuma Desalting Plant Date/Time of Inspection: 4/10/2024 @ 9:30 am

Facility Location (Place): 7301 Calle Agua Salada, Yuma, AZ 85364 County: Yuma

Inspector: Steven Vogel

Mailing Address: 7301 Calle Agua Salada, Yuma, AZ 85364 Telephone: 602-694-1099

Accompanied by: Karen Shanafelt

Responsible Party: US Bureau of Reclaim - Yuma

On-Site Representative: Richard Bash ADEQ Follow-up Contact: S. Vogel

Telephone: 928-343-8313 / 928-276-2845

Title: Operator Title: Inspector/Enforcement Officer

E-mail: rbash@usbr.gov Telephone: 602-694-1099

The ADEQ representative(s) identified above were present at the above address on the above listed date and time. Upon entry to the premises, the ADEQ representative(s) met with me, presented photo identification indicating that they are ADEQ employees and explained:

☒ That the purpose of the inspection is to determine:

☒ Compliance with Title 49 of the Arizona Revised Statutes, Title 18 of the Arizona Administrative Code* and/or:

Arizona Revised Statutes: Title ____49____, Chapter ______2______, Article _______9________.

Arizona Administrative Code: Title ____18____, Chapter ______4______, Article _______________.

Permit/Agreement Number: ____________________________________________________.

☐ Qualification for a license issued pursuant to:

Arizona Revised Statutes: Title ____49____, Chapter ______2______, Article _______9________.

Arizona Administrative Code: Title ___18_____, Chapter _____5_______, Article ______1_________.

☒ That this inspection is conducted pursuant to the authority granted in Arizona Revised Statutes § 49-104(B)(8) and/or:

Arizona Revised Statutes: § __________________41-1009, 49-203(B)(1) ____________________.

Arizona Administrative Code: _____________________ R18-4-207 _______________.

Permit/Agreement Number: _____________________________________.

☒ That the state shall not be barred by the statutes of limitations of actions, according to A.R.S. § 12-510, except as provided in A.R.S. § 12-529 concerning certain claims based on navigability of watercourses. According to 28 U.S.C. § 2462, the U.S. government must commence an action within 5 years after the date the claim first accrued.

☒ Possible applicability of Small Business Bill of Rights pursuant to Arizona Revised Statutes § 41-1001(21)

☐ That the fee for this inspection is: $0.00.

*The Arizona Revised Statutes (A.R.S.) can be found on the internet: www.azleg.state.az.us/ArizonaRevisedStatutes.asp while the Arizona Administrative Code (A.A.C.) can be found at www.azsosaz.gov/public_services/Table_of_Contents.htm.

While I have the right to refuse to sign this form, the ADEQ representatives may still proceed with the inspection.

☐ I have read this notice and discussed any questions or concerns with the ADEQ representatives and I have received the Small Business Bill of Rights.

4/10/2024 Signature of Regulated Person or Authorized On-Site Representative Date

☐ The regulated person or authorized on-site representative refused to sign.

Name of Regulated Person or Authorized On-Site Representative Title

☐ The regulated person or authorized on-site representative was not present at the facility.

Signature of ADEQ Representative Date _________ mailto:rbash@usbr.gov

Rev. 190826

INSPECTION RIGHTS

☐ I understand that I can accompany the ADEQ representative(s) on the premises, except during confidential interviews.

☐ I understand that I have right, on request, to:

Copies of any original documents taken during the inspection, and that ADEQ will provide copies of those documents at ADEQ’s expense;

A split of any samples taken during the inspection, if the split of the samples would not prohibit an analysis from being conducted or render an analysis inconclusive;

Copies of any analysis performed on samples taken during the inspection and that ADEQ would provide copies of this analysis at ADEQ’s expense;

Copies of any documents to be relied on to determine compliance with licensure or regulatory requirements if the agency is otherwise permitted by law to do so.

☐ I also understand that:

Each person who is interviewed by an ADEQ inspector during the inspection must be informed that:

(1) participation in an interview is voluntary, unless legally compelled to participate;

(2) they have the right to have an attorney or other experts in their field present during the interview to represent or advise the regulated person;

(3) the ADEQ inspector may not take any adverse action or treat less favorably or draw any inference as a result of the regulated person’s decision to be represented by an attorney or advised by any other experts in their field;

(4) statements made by the person may be included in the inspection report; and

(5) they have the right to 24 hours to review and revise any written witness statements drafted by the ADEQ inspector on which the ADEQ inspector requests that person’s signature.

If the information and documents provided to the ADEQ inspector become a public record, trade secrets and proprietary and confidential information may be redacted, unless the information and documents are not confidential pursuant to statute.

Each person interviewed during the inspection must be informed that statements made by the person may be included in the inspection report;

Each person whose conversation is tape recorded during the inspection must be informed that the conversation is being tape recorded;

If an administrative order is issued or a permit decision is made based on the results of the inspection, I have the right to appeal that administrative order or permit decision. I understand that my administrative hearing rights are set forth in Arizona Revised Statutes § 41-1092 et seq. and my rights relating to an appeal of a final agency decision are found in Arizona Revised Statutes § 12-901 et seq;

If I have any questions or concerns about this inspection, I may contact the person listed as the ADEQ Follow-up Contact on the front of this form; ADEQ’s Ombudsman at (602) 771-4322 (toll free inside Arizona at

(800) 2345677, extension 771-4322); or the Arizona Ombudsman-Citizens’ Aid office at (602) 277-7292 (toll free at (800) 872-2879);

If I have any questions concerning my rights to appeal an administrative order or permit decision, I may contact ADEQ’s Office of Administrative Counsel at (602) 771-2212 (toll free inside Arizona at (800) 234- 5677, extension 771-2212).

Karen Peters Director

Katie Hobbs Governor

Drinking Water System Field Inspection Report

System Name: Yuma Desalting Plant PWS: AZ0414103 Physical Location: 7301 Calle Agua Salada City, State, Zip: Yuma, AZ 85364 Inspection No.: 444287

County: Yuma Arrival Date and Time: 4/10/2024 @ 9:30 am Mailing Address: 7301 Calle Agua Salada City, State, Zip: Yuma, AZ 85364 Inspector(s): Steven Vogel

Owner/Responsible Party: US Bureau of Reclaim - Yuma Address: 7301 Calle Agua Salada Yuma, AZ 85364 Phone: 928-343-8210 Email: bhgreen@usbr.gov

Inspector Phone: 602-694-1099 Inspector Email: vogel.steve@azdeq.gov

Administrative Contact/Title: Bryon Green Address: 7301 Calle Agua Salada Yuma, AZ 85364 Phone: 928-343-8201 Email: bhgreen@usbr.gov

Classification: C System Grade: D3/T4 Service Connections: 1 Population: 200 Changes/Updates: ☐ Yes

Operator/ID: Richard Bash / OP005416 Phone: 928-343-8313 Email: rbash@usbr.gov

Op. Cert. Grade/Expiration: 3D/4T / June 3, Add/Remove/Update Operator: ☐ Yes

Compliance Summary:

Certified Operator ☒ Yes ☐ No Physical Facilities ☒ Yes ☐ No Monitoring and Reporting ☒ Yes ☐ No

Results of Inspection:

☒ No alleged deficiencies were noted during the course of the inspection. No ADEQ action will result from this inspection.

☐ Alleged deficiencies were noted during the course of the inspection, and all deficiencies were corrected by close of business on the final day of the inspection. No ADEQ action will result from this inspection.

☐ Alleged deficiencies were noted during the course of the inspection. Additional correspondence regarding this inspection may be forthcoming.

If applicable, ADEQ documents its initial determination that the alleged deficiencies are:

☐ Committed intentionally ☐ Not correctable within a reasonable period of time as determined by the agency.

☐ Evidence of a pattern of noncompliance as demonstrated by alleged deficiencies previously identified in an inspection report or other written notice at the same premises.

☐ A significant risk to any person, the public health, safety or welfare or the environment.

Inspection Report Issued: Facility Initial: ADEQ Initial:

mailto:bhgreen@usbr.gov mailto:vogel.steve@azdeq.gov mailto:bhgreen@usbr.gov mailto:rbash@usbr.gov

ADEQ Compliance Assistance Coordinator: Bailey McDade / (602) 771-4164 / McDade.Bailey@azdeq.gov

Owner/AC and/or Update Contact information: ☐ Yes

PHOTOGRAPHS TAKEN DURING INSPECTIONS ARE AVAILABLE ON REQUEST

A. SOURCES Comments Inventory Changes: ☐ Yes

1. Approved Source(s) Add New Source(s). (R18-5-507A) Click here to enter text.

☒ Yes ☐ No

Two wells: 55-504131 (Old), 55-544860 (New), and Surface Water Intake: C141030SI

2. Ground Water Under the Influence of Surface Water (R18-4-212) *If yes, use Surface Water Checklist Addendum

☐ Yes ☒ No

B. WELL REQUIREMENTS Comments

1. Raw water sampling tap installed to collect GW sample (40 CFR §141.402.a.2)

☒ Yes ☐ No ☐ N/A

2. Sample Tap installed at Entry Point to the Distribution System (EPDS) (40 CFR §141.23.a.1)

☒ Yes ☐ No ☐ N/A

EPDS001

Latitude: DMS Longitude: DMS

3. Vent turns down and terminates 2

ft. above the slab with #16-mesh screen. (R18-5-502)

☒ Yes ☐ No ☐ N/A

Operational Air Release Valve Installed. (R18-5-502) (Applicable for vertical turbines or submersible pumps greater than 100 gpm).

☒ Yes ☐ No ☐ N/A

4. Access to well restricted (R18-5-502) ☒ Yes ☐ No ☐ N/A

5. Appropriate Drainage Away from Well. (R18-4-203) ☒ Yes ☐ No ☐ N/A

6. Sanitary Seal and Slab. (R18-4-203) ☒ Yes ☐ No ☐ N/A

C. WELL RECOMMENDATIONS Comments

1. State well number posted ☒ Yes ☐ No ☐ N/A

2. Casing Extends 12” above slab ☒ Yes ☐ No ☐ N/A

D. DISINFECTION REQUIREMENTS Comments Inventory Changes: ☐ Yes

1. Disinfection Compound ANSI/NSF 60 Approved and Container Labelled (R18-4-213) *If system is using gas chlorination, use Gas Chlorination Addendum.

☒ Yes ☐ No ☐ N/A

*Please see gas chlorination addendum Sodium Hypo-Chlorite and UV Light

E. TREATMENT REQUIREMENTS Comments Inventory Changes: ☐ Yes 1.Treatment required Type: (As, N, 4-log, radionuclides, blending, POE, POU, etc.)

*If the system is using POE or POU, use Addendum for PWSs with POE POU devices

☒ Yes ☐ No

Ph Adjustment (Softening), GAC, Cartage Filters, Corrosion Control (Orthophosphate), Ultraviolet Light, Sodium Hypo-Chlorite, and Gas Chlorination

2. 4-log compliance monitoring data available for the past year. (R18-4-121) ☐ Yes ☐ No ☒ N/A

3. 4-log monitoring data above required minimum residual? If below, were required additional monitoring steps taken? (R18-4-121)

☐ Yes ☐ No ☒ N/A

4. Unapproved bypass. (R18-5-509) ☐ Yes ☒ No ☐ N/A

F. TREATMENT RECOMMENDATIONS Comments

1. ADEQ approved operations and maintenance manual available for review

☒ Yes ☐ No ☐ N/A

G. STORAGE REQUIREMENTS Comments Inventory Changes: ☐ Yes

1. Drain is Air Gapped from Sanitary Sewer, Storm Drain, or Irrigation Conveyance. (R18-4-215)

☐ Yes ☐ No ☒ N/A No finished water storage

2. Vents Protected (i.e. #16 Non- Corrodible Mesh). (R18-5-502) ☐ Yes ☐ No ☒ N/A

3. Overflow Pipe Protected with #16 Non-Corrodible Mesh. (R18-5-502) ☐ Yes ☐ No ☒ N/A

4. Hatch has Gasket or Seal, and Locking Device. (R18-5-502) ☐ Yes ☐ No ☒ N/A

5. All Finished Water Storage has Water Tight Cover or Roof (R18-4-122)

☐ Yes ☐ No ☒ N/A

6. Area Within 100 ft. of Tank Graded to Provide Drainage Away from Tank (R18-4-203)

☐ Yes ☐ No ☒ N/A

H. STORAGE RECOMMENDATIONS Comments

1. Working Mechanical, Automatic Gauge, or Alarm ☐ Yes ☐ No ☒ N/A

I. PRESSURE TANK REQUIREMENTS Comments

1. Operational Pressure Gauge (R18-4-203) ☐ Yes ☐ No ☒ N/A

2. Operational Pressure Relief Valve (R18-4-203) ☐ Yes ☐ No ☒ N/A

J. PRESSURE TANK RECOMMENDATIONS Comments

1. Operational Water Level Gauge (R18-4-203) ☐ Yes ☐ No ☒ N/A

K. DISTRIBUTION REQUIREMENTS Comments

1. System Pressure >20 PSI Throughout System. (R18-5-502.B) ☒ Yes ☐ No

2. Cross Connection/Testable Backflow Prevention Devices (car washes, restaurants, hospitals etc.) (R18-4-215)

☒ Yes ☐ No ☐ N/A

3. Separate Non-Potable System with Connections Labelled. (R18-5-502) ☒ Yes ☐ No ☐ N/A

L. GENERAL REQUIREMENTS Comments

1. Emergency Plan for Community System in Accessible Location (R18-4-204)

☐ Yes ☐ No ☒ N/A

The Emergency Operations Plan shall detail the steps that the Community water system will take to assure continuation of service in the following emergency situations; (R18-4-204.A)

i. Loss of source; ☐ Yes ☐ No

ii. Loss of water supply due to major component failure; ☐ Yes ☐ No

iii. Damage to power supply equipment or loss of power; ☐ Yes ☐ No

iv. Contamination of water in distribution system from backflow;

☐ Yes ☐ No

v. Collapse of a reservoir, reservoir roof, or pumphouse structure;

☐ Yes ☐ No

vi. A break in transmission or distribution line; ☐ Yes ☐ No

vii. Chemical or microbiological contamination of the water supply.

☐ Yes ☐ No

The Emergency Operations Plan required by subsection (A) shall address all of the following; (R18-4-204.B)

i. Provisions of alternate sources of water during the emergency;

☐ Yes ☐ No

ii. Notice procedures for regulatory agencies, news media, and users;

☐ Yes ☐ No

iii. Disinfection and testing of the distribution system once service is restored;

☐ Yes ☐ No

iv. Identification of critical components that shall remain in service or be returned to service quickly;

☐ Yes ☐ No

v. Critical spare parts inventory; ☐ Yes ☐ No

vi. Staff training in emergency response procedures. ☐ Yes ☐ No

2. Microbiological Sample Siting Plan (R18-4-126, 40 CFR §141.853) ☒ Yes ☐ No

3. Disinfectant By Product Sample Siting Plan.

(R18-4-124, 40 CFR §141.622) ☒ Yes ☐ No ☐ N/A

4. Lead & Copper Site Sampling Plan (R18-4-111, 40 CFR §141.91) ☒ Yes ☐ No ☐ N/A

5. Components Enclosed by Building or Security Fencing. (R18-5-502) ☒ Yes ☐ No ☐ N/A

6. Appropriate Operation and Maintenance. (R18-4-203) ☒ Yes ☐ No ☐ N/A

7. All Necessary Components Made of ANSI/NSF 61 Approved Material (R18-4-213)

☒ Yes ☐ No ☐ N/A

8. Approval to Construct (ATC) for System Upgrades and Expansions (R18-5-505)

☐ Yes ☐ No ☒ N/A

9. Approval of Construction (AOC) for System Upgrades and Expansions (R18-5-507)

☐ Yes ☐ No ☒ N/A

M. OPERATOR REQUIREMENTS Comments Inventory Changes: ☐ Yes

1. Operator in Direct Charge Certified at Correct Grade. (R18-5-104 A.1) ☒ Yes ☐ No ☐ N/A

2. Onsite Operator for Grade 3 or 4 Facility. (R18-5-104.E) ☒ Yes ☐ No ☐ N/A

3. Relief Operator Certificate No Lower than 1 Grade Below System (R18-5-104 A.5)

☒ Yes ☐ No ☐ N/A

4. Remote Operator <200 Road Miles from Facility. (R18-5-104 F.5) ☐ Yes ☐ No ☒ N/A

5. Remote Operator Inspects Grade 1 and 2 Systems at Least Monthly to ensure proper operation and maintenance. (R18-5-104 F.7) Date of Last Inspection:

☐ Yes ☐ No ☒ N/A

6. The remote operator instructs, supervises and provides written instructions to the onsite representative. (R18-5-104 F.3)

☐ Yes ☐ No ☒ N/A

OBSERVATIONS, RECOMMENDATIONS, AND POTENTIAL DEFICIENCIES:

OBSERVATION:

1. System’s operator added #21 non-corrodible mesh screen to well’s air release valve during the inspection

Inventory Changes to Existing PWS Includes: (please check all appropriate boxes)

PWS Name: ☐ Yes – Classification: ☐ Yes - Activation: ☐ Yes – Inactivation: ☐ Yes - Treatment: ☐ Yes – Disinfectant: ☐ Yes Admin Contact Info: ☐ Yes - Owner Contact Info: ☐ Yes - PWS Population: ☐ Yes – PWS Service Connections: ☐ Yes – Facility/Sampling Point: ☐ Yes – Other: ☐ Yes –

I believe we installed #16

PRE-INSPECTION CHECKLIST Comments

Consumer Confidence Report Delivered in Community Systems (R18-4-117)

☐ Yes ☐ No ☒ N/A

Monitoring Assistance Program Participant (A.R.S 49-360)

☐ Yes ☒ No Not on MAP

Sampling EPDS(s) (quantity): DS0001 & EPDS002

Inventory Changes: ☐ Yes

Required Sampling Sampled By:

COMPLIANCE Comments

Y N N/A ☒ Turbidity System ☒ ☐ ☐

☒ Coliform System ☒ ☐ ☐

☒ Maximum Residual Disinfectant Level

(MRDL)

System ☒ ☐ ☐

☒ Lead & Copper System ☒ ☐ ☐

☒ Disinfection By Products

System ☒ ☐ ☐

☒ Nitrate ☒ System ☐ MAP ☒ ☐ ☐

☒ Nitrite ☒ System ☐ MAP ☒ ☐ ☐

☒ Asbestos ☒ System ☐ MAP ☒ ☐ ☐

☒ Inorganic Compounds

(IOC)

☒ System ☐ MAP ☒ ☐ ☐

☒ Volatile Organic Compounds (VOC)

☒ System ☐ MAP ☒ ☐ ☐

☒ Synthetic Organic Compounds (SOC)

☒ System ☐ MAP ☒ ☐ ☐

☒ Arsenic ☒ System ☐ MAP ☒ ☐ ☐

☐ Radio-chemicals ☐ System ☐ MAP ☐ ☐ ☒

☐ Combined Uranium ☐ System ☐ MAP ☐ ☐ ☒

MAP Participants are Responsible for Increased Monitoring in Excess of One Annual Sample

SYSTEM SKETCH: Yuma Desalting Plan - AZ0414103 DATE: 4/10/2024

Intake C141030SI -> Gas Chlorination -> Wells 55-504131 (Old) & 55-544860 (New) -> TPSW001 (Ph Adjustment (Softening), GAC, Cartage Filters, Corrosion Control (Orthophosphate), Ultraviolet Light, and Sodium Hypo-Chlorite) -> Clear Well (CW) -> EPDS001 -> Distribution

Intake->Wells (Old),(New)->Gas Chlorination->Ph adjustment (Lime Softening)->coagulation (Ferric Sulfate)-.Ph adjustment (sulfuric acid)->Dual Media Filtration->Ph adjustment (sulfuric acid) Clear

Corrosion Control (Orthopolyphosphate)->GAC, Sodium hypochlorite->Sodium bicarbonate-> Well-.Anti-scalant (SHMP)->Anyhrdous Ammonia->Reverse Osmosis (RO)->Ph adjustment (Lime)->

Ultraviolet light->Cartridge Filters->EPDS001-> Distribution

Drinking Water System Field Inspection Report Gas Chlorination

System Name: Yuma Desalting Plant PWS ID: AZ0414103 County: Yuma Inspection No.: 444287 Arrival Date and Time: 4/10/2024 9:30 AM Inspector(s): Steven Vogel

1. Chlorine cylinder stored in upright position in a cool, well-ventilated room; one-ton containers stored on sides on level rack or platform with safety blocks to prevent rolling (R18-4-208)

☒ Yes ☐ No ☐ N/A

2. Chlorine gas containers stored away from other compressed gases, turpentine, ether, finely divided metals, and hydrocarbons. (R18-4-208)

☒ Yes ☐ No ☐ N/A

3. Weighing scale provided for weighing cylinders containing chlorine gas except for installations where automatic switchover from an empty to a full cylinder is provided (R18-4-208)

☒ Yes ☐ No ☐ N/A

4. All cylinders secured to scale or support by chain or other approved means. (R18-4-208)

☒ Yes ☐ No ☐ N/A

5. Air outlet from the room with gas type chlorinator is near the floor and point of discharge is located as not to contaminate air inlets to any buildings and areas used by people. (R18-4-208)

☒ Yes ☐ No ☐ N/A

A. DISINFECTION RECOMMENDATIONS

(For Gaseous Chlorine)

Comments Inventory Changes: ☐ Yes

1. Approved gas masks with a self-contained air supply available where chlorine gas is handled, and stored at a convenient location but not inside any room where chlorine is used or stored (R18-4-208)

2. Bottle of strong ammonia water (10% NH3) available for chlorine leak detection. (R18-4-208)

☒ Yes ☐ No ☐ N/A

3. A leak repair kit approved by the Chlorine Institute provided where ton containers are used. (R18-4-208) ☒ Yes ☐ No ☐ N/A

4. Chlorine cylinders and chlorinators housed in separate rooms on the ground floor. (R18-4-208) ☒ Yes ☐ No ☐ N/A

5. Weights of chlorine cylinders recorded at regular intervals, at least once a day, in order to ascertain the actual quantity of gas being used (R18-4-208)

Form updated 1/22/2018 Page 1

Misael Cabrera Director

Douglas A. Ducey Governor

SURFACE WATER SOURCES – Yuma Desalting Plan AZ0414103

Physical Facilities – Check all that Apply Inventory Changes: ☐ Yes Comments:

☐ Bar Screens ☒ Rapid Mix ☒ Pre-sedimentation ☒ Chemical Feed ☒ Taste/Odor control ☐ Grit Chamber ☒ Flocculation ☒ Sedimentation

☒ Disinfection ☐ Aeration ☒ Filters ☒ Coagulation Other:

Chemical Feed – Check all that Apply Inventory Changes: ☐ Yes Comments:

☐ Alum ☐ PAC

☒ GAC ☐ Polymer ☐ Ferric Chloride ☒ Other, specify: Ferris Sulfate

☒ Chlorine ☐ Chlorine Dioxide

☒ Liquid Sodium hypochlorite ☐ Ozone ☒ Gas ☒ Chloramine

☐ Fluoride

Intake Facilities – Pre-sedimentation Deficiencies: ☐ Yes ☒ No

System description:

☐ Screen not operational

☐ Intake pumps not functional

☐ Poor housekeeping

☐ Contaminants near water supply source

☐ Intake structure does not have sufficient capacity to meet anticipated water demand

☐ Intake structure at bottom of source, not submerged

☐ Intake structure not cribbed

Source water measurements:

☒ pH: ____ ☒ Flow: ____ ☒ Turbidity: _____ ☒ Alkalinity: _____

☒ Temperature: ____ ° ☒ C or ☐ F

☐ Particle Count: ____

☐ ORP: ___

☐ TOC: ___

☒ TDS: ___

Coagulation – Rapid Mix Deficiencies: ☐ Yes ☒ No

System description:

☐ Coagulant machine inoperable

☐Mechanical mixers inoperable, or not in use

☐ Inadequate chemical storage

☐ Improper or unsafe chemical handling

☐ Dose not based on raw water turbidity

Flocculation Deficiencies: ☐ Yes ☒ No

System description:

☐Mechanical mixers inoperable or inadequate Type of mixer:

☐ Paddle

☐ Turbine ☒ Propeller

☐ paddle wheel Type of drive: ☒ VFD ________ ☐ Fixed _______

Flocculation:

☐ not visible ☒ visible

☐ Other: __________________________________ Effluent measurements:

☐ Turbidity: _____ ☒ Alkalinity: _____

☒ Temperature: ____ ° ☒ C or ☐ F

Sedimentation Deficiencies: ☐ Yes ☒ No

System description:

System has minimum of two sedimentation basins provided to allow for service and maintenance:

☐ Yes ☐ No ☒ N/A

☐ Sedimentation basins not capable of being dewatered

☐Mechanical mixers inoperable or inadequate ☒ Type of mixer (paddle, turbine, propeller, paddle wheel)

☐Weirs not level or short circuiting

☐ Excess sludge on clarifier bottom Effluent measurements:

Turbidity: _____ Nitrate: _____ Velocity:_____ Detention time: ______ Basin overflow rate: ______

Type of drive: ☐ VFD _______ ☐ Fixed ________

☐ Operation and Maintenance manual not available for review

Solids Handling Deficiencies: ☐ Yes ☒ No

System description: Solids are sent to ponds 22 miles away

☐ Type of process:

☐ Gravity thickening ☐ Belt press ☐ Plate Settler

☐ Centrifuge ☒ Solar drying beds

☐ Chemical addition: _______________________

☐ Insufficient testing: ☐ VS, TS, %

☐ Poor housekeeping

☐ Other: __________________________________

Filtration Deficiencies: ☐ Yes ☒ No

Type of Filtration Practiced: ☒ Conventional ☐ Direct ☐ Alternative ☐ Slow Sand ☐ DE ☐ UF

System description:

☒ Media meets ANSI/NSF 61 standard

☒ sand ☒ anthracite ☐ activated ☐ carbon ☐ membrane Depth of media: Sand 10” & Anthracite 20” Minimum of two filters provided for treatment:

☒ Yes ☐ No ☐ N/A

☐ Empty bed contact time

☐ Air scour inadequate, boiling, uneven, missing

☐ Surface wash Inadequate

☐ Insufficient filter media depth

☐ No backwash capability ☒ Not backwashing with filtered water

☐ Excessive amount of media lost during backwash Time since media visually checked:

Time since media changed: Years

☐ Direct cross-connection between potable and backwash water

☐ Backwash discharge without a NPDES Permit Backwash based upon:

☐ head loss in feet ☒ run time in hours

☐ after reaching NTU Filter to waste after backwash or plant startup:

☒ Yes ☐ No ☒ No flow rate indicator for backwash process Effluent measurements:

pH: Yes Fluoride: ______ Turbidity: Yes Total Coliforms: _____ Chlorine Residual: ______ Final Particle count: ______

Note: Backwashing is with filtered water

Disinfection Deficiencies: ☐ Yes ☒ No

Disinfectant Type: Gas, Hypo-chlorination & UV Light

Meets ANSI/NSF 60 standard ☒ Yes ☐ No System Description:

☐ CT time inadequate

☐ Inadequate residual

☐ Required equipment not installed

☐ No standby equipment

☐ Disinfectant container not labeled

☐ Equipment not operating properly

☐ Disinfectant feed tank empty

☐ Room not properly vented

☐ No inspection windows

☐ No ammonia for leak detection

☐ S.C.B.A. not mounted outside CI room

☐ Room fan switch not outside

☐ No daily log of free chlorine residual

☐ No chlorine test kit

☐ Effluent disinfectant residual

☐ Other, specify: ______________________________

Reservoir/Storage Tank N/A Deficiencies: ☐ Yes ☒ No

Capacity/Description:

☐ No storage or insufficient storage

☐ Tank needs repair

☐ No overflow pipe installed

☐ Overflow pipe not properly screened

☐ No splash block below overflow

☐ Inadequate or no hatch curb

☐ Hatch not sealed/secured (locked)

☐ Excessive debris present in reservoir

☐ Excessive debris present around storage tank

☐ Tank vent inadequately installed

☐ Vent not screened

☐ No tank drain valve

☐ Storage tank drain not air gapped from storm drain Water level indicator type: ______________________

☐ Other, specify: ______________________________

Pressure Tank Deficiencies: ☐ Yes ☒ No

☐ No pressure gauges

☐ No bottom drain valve

☐ No water level sight glass

☐ Booster glands leak

☐ No blow off for excess air

☐ Compressor not operational

☐ No safety relief valve

☐ Other:

Booster Pumps Deficiencies: ☐ Yes ☒ No

☒ Pump capable of providing 20 psi in distribution system ☒ Booster pumps have adequate capacity

☐Moving parts lack protection

☐ Booster glands leak ☒ Check valve in good repair

☐ Other: