Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to obtain the Small Water System Chlorination Report Form and open it in the editor for input.
2. Begin by filling in the public water system name at the top of the form. Ensure that the name is clearly printed to avoid any confusion.
3. Next, enter the chlorination date. This is the date when the chlorination process took place and should be formatted as month/day/year.
4. In the table provided, list the gallons pumped. This column is necessary only if your system utilizes a water meter. Ensure that the amount is accurately recorded.
5. Then, fill in the ‘Amount Used’ column. This should reflect the quantity of chlorine added to your solution tank for that month.
6. Document the free chlorine residual in the relevant field. This is critical information that indicates the effectiveness of the chlorination process.
7. Record your Public Water System Identification Number (PWSID #) as well as the month and year of the report.
8. Ensure that the city or town of your water system is clearly mentioned, along with the name of the person who collected the samples.
9. If applicable, record any bacteria samples taken, including the date, location, and residual readings from those samples.
10. Make a note of any problems or comments in the section provided at the end of the form. This can include any irregularities encountered during sampling or chlorination.
11. Finally, once all sections have been filled out, review the form for accuracy. You can then save changes, download, print, or share the completed report as required.

Complete your documentation online today and ensure compliance with water safety standards.