Drinking Water Forms & Reporting Formats

 

The forms on this page are for use by public drinking water systems and laboratories.

62-555.900 Forms and Instructions

The forms used by the Department in the Public Water System Supervision Program are adopted and incorporated into the rule that references it. Each form is listed by rule number, which is also the form number, title, and effective date. Please note that rules 62-555.900 (13), (14), and (15), Florida Administrative Code (F.A.C.) have been deleted. In accordance with 62-555.900, F.A.C., persons and public water systems shall report to the Department using the forms listed below or using computer-generated versions of the forms listed below provided such versions are identical to the forms listed below in every respect other than the font type and style, font size, and character spacing.

Rule Number/Title	Effective	Format
62-555.900(1) Application for a Specific Permit to Construct PWS Components	8/28/03	PDF	Word
62-555.900(2) Monthly Operation Report for Subpart H Systems	10/14/04	Excel
62-555.900(3) Monthly Operation Report for PWSs Treating Raw Ground Water or Purchased Finished Water	8/28/03	PDF	Word
62-555.900(4) Monthly Operation Report for Consecutive Systems that Do Not Treat Water	8/28/03	PDF	Word
62-555.900(5) Monthly Operation Report for PWSs Fluoridating Water	8/28/03	PDF	Word
62-555.900(6) Monthly Operation Report for Consecutive Systems that Receive Purchased Finished Water from a Subpart H System	4/03/03	PDF	Word
62-555.900(7) Notice of Intent to Use the General Permit for Construction of Water Main Extensions for PWSs	8/28/03	PDF	Word
62-555.900(8) Application for Transfer of a PWS Construction Permit	8/28/03	PDF	Word
62-555.900(9) Certification of Construction Completion and Request for Clearance to Place Permitted PWS Components into Operation	8/28/03	PDF	Word
62-555.900(10) Asbestos-Free Certification or Asbestos Sampling Plan for PWSs	8/28/03	PDF	Word
62-555.900(11) Monthly Operation Report for Summation of Finished-Water Production by CWSs that Have Multiple Treatment Plants	8/28/03	PDF	Word
62-555.900(12) PWS Sampling Plan for Lead and Copper Tap Samples and Water Quality Parameters	8/28/03	PDF	Word
62-555.900(16) PWS Certification of Notification of Lead and Copper Tap Sample Results	8/28/03	PDF	Word
62-555.900(17) Lead Public Education Program Report for PWSs	8/28/03	PDF	Word
62-555.900(18) Notice of Intent to Use the General Permit for Construction of Lead or Copper Corrosion Control, or Iron or Manganese Sequestration, Treatment Facilities for Small or Medium PWSs	8/28/03	PDF	Word
62-555.900(19) Certification of Delivery of Consumer Confidence Report	4/10/03	PDF
62-555.900(20) New Water System Capacity Development Financial and Managerial Operations Plan	8/28/03	PDF	Word
62-555.900(21) Certification of Delivery of Consumer Confidence Information to Supplied Systems	4/10/03	PDF	Word
62-555.900(22) Certification of Delivery of Public Notice	1/17/05	PDF	Word
62-560.545(2) Reduced Monitoring Application Questionnaire for Synthetic Organic Contaminants	N/A	PDF	Word

Laboratory Reporting Formats

Analytical results for samples taken pursuant to Chapter 62-550, Florida Administrative Code, shall be reported by the laboratory in a format which includes all of the required information described in the documents provided below. Laboratories may use computer generated versions of the formats provided such versions are identical in every respect other than print size, type, and spacing. If laboratory analysis reports are submitted without all of the required information, as set forth below, the submittal will be rejected. (Reference Rule 62-550.730, Florida Administrative Code)

Reporting Format Rule Reference	Format
62-550.730: Format to be used for reporting all drinking water chemical analysis results except for lead and copper tap samples and water quality parameter samples.	PDF	Word
62-550.730: Format to be used for reporting all drinking water bacteriological analysis results.	PDF	Word
*62-550.730(4)(a): Lead and copper tap samples taken from the interior taps of private residences.	PDF	Word
*62-550.730(4)(c): Water quality parameter samples taken from the entry point to the distribution system and at points within the distribution system.	PDF	Word
*The Drinking Water Section's 2004 Book of Forms and Example Reporting Formats incorrectly references the reporting formats 62-550.730(4)(a) "Lead and Copper Tap Sample Analysis and Result Ranking" and (4)(c) "Distribution and Entry Point Water Quality Parameters" as 62-550.730 (5)(a) and (5)(c) respectively. We apologize for this error. Please use the corrected versions of the reporting formats as provided above.
The Following Form is for internal use of the Department of Environmental Protection and the Department of Health:
Interagency Transfer of a Public Water System	PDF

Example Stage 1 D/DBPR Reporting Formats

The following example reporting formats were developed to assist PWSs in reporting parameters for the Stage 1 Disinfectants/Disinfection Byproducts Rule(D/DBPR).  PWSs are not required to use the example reporting formats. PWSs can use any format they wish as long as the information required by 62-550.821(12), F.A.C. is provided.

Example Reporting Formats	Format
Disinfectant Residual (Chlorine or Chloramines)	PDF	Word
Disinfection Byproducts (Total Trihalomethanes (TTHMs) and Haloacetic Acids Five (HAA5s)	PDF	Word

Example Stage 1 D/DBPR Monitoring Plan Format

The following example monitoring plan format was developed to assist PWSs in preparing a Stage 1 Disinfectants/Disinfection Byproducts Rule (D/DBPR) monitoring plan. PWSs are not required to use the example monitoring plan format. PWSs can use any format they wish as long as the information required by 62-550.821(11), F.A.C., is provided.

Example Monitoring Plan Format	Format
Stage 1 D/DBPR Monitoring Plan Example	PDF	Word