Follow the steps to successfully fill out the form online.

1. Click 'Get Form' button to access the form and open it in the online editor.
2. Fill in the public water system name, source water type(s), reporting month, and year at the top of the form. These details help identify the specific water system being reported.
3. Provide the date the report is submitted in the specified MM/DD/YYYY format, ensuring that the date is current and accurately reflects the submission date.
4. Indicate the county, town, village, or city where the water system operates. Select the appropriate source water type (surface, ground, or GWUDI) and whether you are purchasing water with or without subsequent chlorination.
5. Enter the Public Water Supply ID and the identification numbers for treatment plants used. Specify which fluoride compound is utilized for fluoridation.
6. Detail the fluoride residual testing method used and the identification of fluoride injection points, ensuring to follow your operational practices.
7. Document the source(s) in use, treated water volume, gaseous cylinder weight, and the amount of chlorination liquid added. Ensure all data is accurate and reflective of your operations.
8. Fill in the details of chlorination used per day and fluoride compound usage per day. Document the free chlorine residual at the entry point and other treatments or readings as applicable.
9. Complete the microbiological samples and free chlorine residual section. Indicate the sample location, date, sample type, total coliform positive, and E. coli positive results.
10. Provide information regarding microbiological monitoring samples required and taken, and indicate if any M&R or MCL violations occurred. If so, specify the reasons.
11. Record the sample collector's name and date, and the name of the NYSDOH certified laboratory responsible for the samples.
12. Address any incidents related to MCL violations or emergency problems, and provide any necessary comments in the comments section.
13. Once all sections are filled out, review the document for accuracy. Save changes, download, or print the completed form for submission.

Complete your documents online today to ensure timely compliance with reporting requirements.