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1、MICHIGANDEPARTMENTOFENVIRONMENTALQUALITYRESOURCEMANAGEMENTDIVISIONLEADANDCOPPERREPORTANDCONSUMERNOTICEOFLEADRESULTCERTIFICATEFORCOMMUNITYWATERSUPPLYIssuedunderauthorityof1976PA399andAdministrativeRules,asamended.Failuretosubmitthisinformationisaviolationo
2、ftheActandmaysubjectthewatersupplytoenforcementpenalties.AdministrativeRuleR?325.10710drequireswatersuppliestoreportleadandcoppermonitoringinformationwithin10?daysaftertheendofthemonitoringperiod.Thisformmaybeusedtomeetthisrequirement.Submittheinformation
3、totheappropriateDepartmentofEnvironmentalQuality(DEQ)districtoffice.Fordistrictofficeaddresses,visitwww.michigan.gov/deqandclickonLocations.1.WaterSupplyName:2County:3.WSSN:4.Population:5.MonitoringPeriod:From:To:6.Minimum#ofSamplesRequired:7.#ofSamplesTa
4、ken:8.NameofCertifiedLaboratory:9.SAMPLECRITERIA:YesNoExplainNoresponsesinCommentsblock.a.Arethesamesamplingpointsusedasinthepreviousmonitoringperiod?b.AreallsamplesfromTier1sites?FormoreinformationseeInstructionsparagraph11,subparagraph“SampleCategory.”c
5、.AreallsamplesfromTier1,2,or3sitesgivingTier1priority?d.IfnoTier1,2,or3sitesareavailable,doallsiteshaveplumbingmaterialscommonlyfoundatotherlocationsinthesystem?e.Istheminimumnumberofleadservicelinesamplestaken(whenapplicable)?Comments:10.NAME:Name:Title:
6、Phone:Date:311.TAPSAMPLINGDATA:(Useadditionalsheetsasneeded)WaterSupplyName/CountyWSSNRESULTS:SampleLocationSampleDateSampleCategory1ServiceLines2BldgPlumb-ing2Lead(ppb)Copper(ppb)Lab#1SampleCategory:Enteranumber1through6todesignatethecategoryoftapsamples
7、ite.FormoreinformationseeInstructionsparagraph11,subparagraph“SampleCategory.”2Materialsusedforservicelineandbuildingplumbing:EnterC=copper;G=galvanized;L?=?lead;orP=plastic.TOBEDETERMINEDBYDEQ90thpercentileAveMax#>ALPbCu312.CONSUMERNOTICEOFLEADRESULTCERT
8、IFICATION:EachCommunityWaterSupply(CWS)mustdeliveraConsumerNoticeOfLeadResulttooccupantsofeachlocationsampledwithin30daysofknowingthesampleresultunderR?325.10410(5).Notlaterthan3monthsfollowingtheendofthemonitoringp
