Free 53282.pdf - Indiana

MONTHLY CHLORINE DIOXIDE MONITORING
State Form 53282 (6-07)

Indiana Department of Environmental Management (IDEM) Office of Water Quality - Drinking Water Branch - Compliance Section

INSTRUCTIONS:

1- For each day of the month, record a daily chlorine dioxide sample measurement taken at the point of entry (POE). 2- Indicate "yes" or "no" if the daily chlorine dioxide POE measurement exceeds 0.8 mg/L. 3- On each day following a daily chlorine dioxide POE measurement that exceeds 0.8 mg/L, record sample results for three distribution system samples taken. The required distribution system monitoring locations depend on the disinfectant residual and whether additional disinfectant is added after the entrance to the distribution system: - If chlorine dioxide or chloramines are used to maintain a disinfectant residual in the distribution system, or if chlorine is used to maintain a disinfectant residual in the distribution system and there are no disinfection addition points after the entrance to the distribution system, for example, no booster chlorination, the system shall take three samples as close to the first customer as possible, at intervals of at least six hours. - If chlorine is used to maintain a disinfectant residual in the distribution system and there are one or more disinfection addition points after the entrance to the distribution system, for example, booster chlorination, the system shall take one sample at each of the following locations: at the first customer, at a location representing average residence time, and at a location representing maximum residence time.

MONTHLY CHLORINE DIOXIDE MONITORING (page 2)
State Form 53282 (6-07)

PWSID # System Name: Treatment Plant Name/Number:
Please submit completed forms to:

Submitted by:

Month

Year

IDEM OWQ Drinking Water ­ Mail Code 66-34 100 N. Senate Ave. Indianapolis, IN 46204-2251

Disinfectant used to maintain a disinfectant residual in the distribution system: Are there any disinfection addition points after the point-of-entry to the distribution system? Point-Of-Entry (POE) Chlorine Dioxide Samples Is the level > 0.8 mg/L?

Day 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

Level (mg/L)

Three (3) Distribution System Chlorine Dioxide Samples st Level at 1 customer at least 6 Level at 1 st customer at least 6 Level at hours later or end of hours later or location of average 1st distribution system (if booster residence time (if booster customer chlorination practiced) chlorination practiced) (mg/L) (mg/L) (mg/L)

Dates which chlorine dioxide concentration > 0.80 mg/L: