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Consumer Confidence Report Information Specific to Your Community Public Water System Fill this form out with information specific to your system. You should be adding some information of your own and deleting some of the information already in the form. For example, before you send this, the second part of the report*, to your customers, you should delete any text in italics, such as the text in this sentence, because all of the text in italics is instructions directed at you, not your customers. *The first part of the report is “Consumer Confidence Report: General Information Required in All Consumer Confidence Reports. Year this report covers: Insert year this report covers here. Source(s) of Water Type(s) of water: Leave one of the following three in and erase the other two. Groundwater

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Page 1: Consumer Confidence Report Information Specific … · Web viewConsumer Confidence Report Information Specific to Your Community Public Water System Fill this form out with information

Consumer Confidence Report Information Specific to Your

Community Public Water System

Fill this form out with information specific to your system.

You should be adding some information of your own and deleting some of the information already in the form.

For example, before you send this, the second part of the report*, to your customers, you should delete any text in italics, such as the text in this sentence, because all of the text in italics is instructions directed at you, not your customers.

*The first part of the report is “Consumer Confidence Report: General Information Required in All Consumer Confidence Reports.”

Year this report covers: Insert year this report covers here.

Source(s) of Water

Type(s) of water: Leave one of the following three in and erase the other two.

Groundwater Surface waterBoth groundwater and surface water

Any commonly used name of the body(ies) of water: Insert name(s) of aquifer(s), lake(s), reservoir(s), etc.

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Consumer Confidence Report Information Specific to Your Community Public Water System

Location(s) of the body(ies) of water: Insert the city or county of the body(ies) of water.

Source Water Assessment Protection

You can access your assessment report on Drinking Water Watch (http://dww.tceq.state.tx.us/DWW/) by querying for your system and then, under Water System Detail, in the upper left-hand corner, clicking on “Source Water Assessment Results.” Depending on what the assessment report says, include one of the following four paragraphs in your Consumer Confidence Report. Delete the other three.

1. If your assessment report has at least one contaminant listed as highly susceptible, use this text:The TCEQ completed an assessment of your source water and results indicate that some of our sources are susceptible to certain contaminants. The sampling requirements for your water system are based on this susceptibility and previous sample data. Any detections of these contaminants may be found in this Consumer Confidence Report. For more information on source water assessments and protection efforts at our system, contact Insert name of person to contact.

2. If your assessment report has no contaminants listed as highly susceptible, use this text:The TCEQ completed an assessment of your source water and results indicate that our sources have a low susceptibility to contaminants. The sampling requirements for your water system are based on this susceptibility and previous sample data. Any detections of these contaminants will be found in this Consumer Confidence Report. For more information on source water assessments and protection efforts at our system contact Insert name of person to contact.

3. If there are no source water assessment results available for your system on Drinking Water Watch, use this text:A Source Water Assessment for your drinking water source(s) is currently being conducted by the TCEQ and should be provided to us this year. The report will describe the susceptibility and types of constituents that may come into contact with your drinking water source based on human activities and natural conditions. The information in this assessment will allow us to focus our source water protection strategies.

4. If you purchase 100% of your water, use this text:

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Consumer Confidence Report Information Specific to Your Community Public Water System

The TCEQ has completed a Source Water Assessment for all drinking water systems that own their sources. This report describes the susceptibility and types of constituents that may come into contact with the drinking water source based on human activities and natural conditions. The system(s) from which we purchase our water received the assessment report. For more information on source water assessments and protection efforts at our system, contact Insert name of person to contact.

Variance(s) or Exemption(s)

If your water system is operating under a variance or exemption from the Safe Drinking Water Act granted under Section 290.102(b)(4) of Title 30 of the Texas Administrative Code you must include the following. If you are not operating under such a variance or exception, you can delete this section (the Variance(s) or Exemption(s) section):

Explanation of the variance or exemptionInsert explanation here.

Date the variance or exemption was issued expiresInsert the date here.

Date the variance or exemption was issued expiresInsert the date here.

Brief Status on the Steps the System is Taking to Comply with the Terms and Schedules of the Variance or ExemptionInsert a brief status report on the steps you are taking (such as installing treatment processes or finding alternative sources of water) to comply with the terms and schedules of the variance or exemption.

Notice of Any Opportunity for Public Input on the Review or Renewal of the Variance or ExemptionInsert a notice of any opportunity for public input on the review or renewal of the variance or exemption.

Definitions

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Consumer Confidence Report Information Specific to Your Community Public Water System

If your report contains any data on a contaminant for which the US EPA has set a treatment technique or an action level (see following list), you must include the following two definitions in the report.

Fecal indicators (enterococci or coliphage)Total organic carbonTurbidityCopperLeadAcrylamideEpichlorohydrin

If your report does not contain any data on any of these contaminants, then you can delete this section (the Definitions section in this document)

Treatment technique (TT): A required process intended to reduce the level of a contaminant in drinking water.

Action level (AL): The concentration of a contaminant which, if exceeded, triggers treatment or other requirements that a water system must follow.

Information on Detected Contaminants

If a contaminant was detected in your water in the year the report covers, you are required to include that contaminant and its corresponding information in a table. Also, if you are on a reduced sampling schedule and the most recent detection of a contaminant was within the last five years*, you are required to include that contaminant and its corresponding information in a table.

If not, you may delete that contaminant and its row or table.

However, you may wish to leave in any contaminants that were not detected, as this is a chance to show your customers how clean your water is.

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Consumer Confidence Report Information Specific to Your Community Public Water System

*If you are on a reduced sampling schedule and the most recent detection of a contaminant was within five years from December 31 of the year the report covers (for example, for reports covering 2011, contaminants detected in as far back as 2007), you are required to include the following statement:

The data presented in the report is from the most recent testing done in accordance with the regulations.

If you distribute water to your customers from multiple hydraulically independent distribution systems that are fed by different raw water sources, you are required to either:

- include in the table(s) a separate column for each service area, and identify each separate distribution system; or - produce a separate report for each service area.

Total Coliform BacteriaIf you are a system that collected less than 40 total coliform bacteria samples per month in any month

during the year the report covers, and you detected total coliform bacteria, fill out this table. If not, delete this table.

You should add more rows to this table if you have more detections to report than there are rows.

Name of Microbiological

Contaminant Date of Detection

Maximum Contaminant

Level Goal

Total ColiformMaximum

Contaminant Level

Highest Number of Positive

Samples in a Month

Was this a violation?

Likely Source of Contamination

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that

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Consumer Confidence Report Information Specific to Your Community Public Water System

case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed below.

Total coliform bacteria

Presence of coliform bacteria in more than 1 sample

per month.

Naturally present in the environment.

Total coliform bacteria

Presence of coliform bacteria in more than 1 sample

per month.

Naturally present in the environment.

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Consumer Confidence Report Information Specific to Your Community Public Water System

Total Coliform BacteriaIf you are a system that collected at least 40 total coliform bacteria samples per month during every

month of the year the report covers, and you detected total coliform bacteria, fill out this table. If not, delete this table.

You should add more rows to this table if you have more detections to report than there are rows.

Name of Microbiological

Contaminant Date of Detection

Maximum Contaminant

Level Goal

Total ColiformMaximum

Contaminant Level

Highest Monthly Percentage of

Positive SamplesWas this a violation?

Likely Source of Contamination

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on

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Consumer Confidence Report Information Specific to Your Community Public Water System

the likely source, you must include one or more of the typical sources listed below.

Total coliform bacteria

Presence of coliform bacteria in

more that 5% of monthly samples

Naturally present in the environment.

Total coliform bacteria

Presence of coliform bacteria in

more that 5% of monthly samples

Naturally present in the environment.

Fecal Coliform and E. coliYou should add more rows to this table if you have more detections to report than there are rows.

Name of Microbiological

ContaminantDate of

Detection

Maximum Contaminant

Level Goal

Fecal Coliform or E. Coli Maximum

Contaminant Level

Total Number of Positive E. Coli or Fecal

Coliform Samples

Range of Detected Levels

Was this a violation?

Likely Source of Contamination

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are

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Consumer Confidence Report Information Specific to Your Community Public Water System

required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed below.

Fecal coliform 0A routine sample

and a repeat sample are total

coliform positive, and one is also

fecal coliform or E. coli positive.

Human and animal fecal waste.

E. coli 0A routine sample

and a repeat sample are total

coliform positive, and one is also

fecal coliform or E. coli positive.

Human and animal fecal waste.

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Consumer Confidence Report Information Specific to Your Community Public Water System

Fecal IndicatorsYou should add more rows to this table if you have more detections to report than there are

rows.

Name of Microbiological

Contaminant Date of Detection

Treatment Technique or

Specific Action Level

Total Number of Positive Samples

Was this a violation?

Likely Source of Contamination

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific

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Consumer Confidence Report Information Specific to Your Community Public Water System

information on the likely source, you must include one or more of the typical sources listed below.

EnterococciHuman and animal

fecal waste

ColiphageHuman and animal

fecal waste

You are required to include and fill out the following table only if you are a groundwater system and

1. You received notice from a laboratory of a fecal indicator-positive groundwater source sample and

2. That sample has not been invalidated by the TCEQ executive director.

You are also required to continue to include and fill out the following table for any positive sample from years previous to the year the report covers until the TCEQ executive director determines that the fecal contamination in the groundwater source is addressed. You should add more rows to this table if you have more detections to report than there are rows.

Additional Information on Detections of Fecal Indicator(s) in GroundwaterYou should add more rows to this table if you have more detections to report than there are

rows.

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Name of Fecal Indicator

Date of Detection

Actions Taken to Address the Fecal Contamination

in the Groundwater Source and the Date of

Each Action

The Plan Approved by the TCEQ Executive Director

and Schedule for Correction including

Interim Measures, Progress to Date, and Any

Interim Measures Completed. Potential Health Effects

Source of Contamination (if the source

is known)

EnterococciFecal indicators are microbes whose presence indicates that the water may be contaminated with human or animal wastes. Microbes in these wastes can cause short-term health effects, such as diarrhea, cramps, nausea, headaches, or other symptoms. They may pose a special health risk for infants, young children, some of the elderly, and people with severely compromised immune systems.

Human and animal fecal

waste

ColiphageFecal indicators are microbes whose presence indicates that the water may be contaminated with human or animal wastes. Microbes in these wastes can cause short-term health effects, such as diarrhea, cramps, nausea, headaches, or other symptoms. They may pose a special health risk for infants, young children, some of the elderly, and people with severely compromised immune systems.

Human and animal fecal

waste

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Consumer Confidence Report Information Specific to Your Community Public Water System

You are required to include and fill out the following table if you received notice from the TCEQ executive director of a significant deficiency and the executive director has not yet determined that you have corrected all of your deficiencies. You are also required to continue to include and fill out the following table for any significant deficiencies from years previous to the year the report covers until the TCEQ executive director determines that you have corrected the deficiency. You should add more rows to this table if you have more significant deficiencies to report than there are rows..

Uncorrected Significant Deficiencies

What the Significant Deficiency Was/Is

Date the Significant Deficiency

Was Identified

by the TCEQ

Plan Approved by the TCEQ and Schedule for Correction, including Interim Measures, Progress to Date, and Any Interim Measures

Completed

If the deficiency was corrected since last year’s Consumer Confidence Report, you are required to fill in this column. If not,

you can delete this column.How the Deficiency Was Corrected and the

Date of the Corrections

Total Organic Carbon

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Consumer Confidence Report Information Specific to Your Community Public Water System

You should add more rows to this table if you have more detections to report than there are rows.

Constituent Low Average High Treatment Technique or

Specific Action Level

MCLG Unit of Measure

Source of Constituent

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed

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Consumer Confidence Report Information Specific to Your Community Public Water System

below.

Total Organic Carbon

Naturally present in the environment.

Total Organic Carbon

Naturally present in the environment.

Turbidity You should add more rows to this table if you have more detections to report than there are rows.

Limit (for Treatment

Technique Being Used)

Level Detected

Explanation of Reasons for Measuring Turbidity

Was this a violation? Likely Source of

ContaminationIn this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information

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Consumer Confidence Report Information Specific to Your Community Public Water System

on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed below.

Highest Single Measurement

Soil runoff.

Lowest Monthly % of Samples Meeting Turbidity Limit

Soil runoff.

Radioactive Contaminants

Unless your water system has been designated by by the TCEQ as "vulnerable" to, or "contaminated" by, man-made radiation, you do not have to report on beta particle or photon radioactivity, even if you had a detect, and in the following table you could

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delete the row on Beta/photon emitters. At this time (2012) there are no community water systems in Texas that have been designated by the TCEQ as "vulnerable" to, or "contaminated" by, man-made radiation.

If you choose to include this information, you should add more rows to this table if you have more detections to report than there are rows.

Name of Radioactive Contaminant Collection

Date

If sampling

takes place

once per year or

less, Highest Level

Detected

or

If sampling

takes place more

than once per year at each

sampling point,

Average Level

Detected at the

Sampling

Range of Levels

Detected MCLG MCL

Unit of Measure-

mentWas This a Violation?

Likely Source of Contamination

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed below.

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Point with the

Highest Average Level of

All Sampling

PointsBeta/photon emitters 0 50* pCi/L Decay of natural and man-made

deposits

Alpha emitters 0 15 pCi/L Erosion of natural deposits

Combined radium 0 5 pCi/L Erosion of natural deposits

Uranium 0 30 µg/L Erosion of natural deposits

* EPA considers 50pCi/L to be the level of concern for beta particles

Inorganic ContaminantsYou should add more rows to this table if you have more detections to report than there are

rows.

Name of Inorganic Contaminant Collection Date

If sampling

takes place

once per year or

less, Highest Level

Detected

Range of Levels

Detected

MCLG MCL(unless

treatment technique or action level is

specified)

Unit of MCLG

and MCL

Was This a Violation?

Likely Source of Contamination

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected

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Consumer Confidence Report Information Specific to Your Community Public Water System

or

If sampling

takes place more

than once per year at each

sampling point,

Average Level

Detected at the

Sampling Point with

the Highest Average Level of

All Sampling

Points

contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed below.

Antimony 6 6 ppb Discharge from petroleum refineries; fire retardants; ceramics;

electronics; solder. Arsenic n/a 10 ppb Erosion of natural deposits; Runoff

from orchards; Runoff from glass and electronics wastes.

Asbestos 7 7 MFL Decay of asbestos cement water mains; Erosion of natural deposits

Barium 2 2 ppm Discharge of drilling wastes; Discharge from metal refineries;

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Erosion of natural deposits.Beryllium 4 4 ppb Discharge from metal refineries and

coal burning factories; Discharge from electrical, aerospace, and

defense industries.Bromate 0 10 ppb By-product of drinking water

disinfection.Cadmium 5 5 ppb Corrosion of galvanized pipes;

Erosion of natural deposits; Discharge from metal refineries; Runoff from waste batteries and

paints.Chlorite 0.8 1 ppm By-product of drinking water

disinfection.Chromium 100 100 ppb Discharge from steel and pulp mills;

Erosion of natural deposits.Cyanide 200 200 ppb Discharge from steel/metal

factories; Discharge from plastic and fertilizer factories

Fluoride 4 4 ppm Erosion of natural deposits; Water additive which promotes strong

teeth; Discharge from fertilizer and aluminum factories.

Mercury 2 2 ppb Erosion of natural deposits; Discharge from refineries and

factories; Runoff from landfills; Runoff from cropland.

Nitrate (measured as Nitrogen) 10 10 ppm Runoff from fertilizer use; Leaching from septic tanks, sewage; Erosion

of natural deposits.Nitrite (measured as Nitrogen) 1 1 ppm Runoff from fertilizer use; Leaching

from septic tanks, sewage; Erosion of natural deposits.

Selenium 50 50 ppb Discharge from petroleum and metal refineries; Erosion of natural

deposits; Discharge from mines.Thallium 0.5 2 ppb Leaching from ore processing sites;

Discharge from electronics, glass, and drug factories.

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If your system detected arsenic levels above 5 micrograms per liter but below the maximum contaminant level (MCL), include the following language. Otherwise, you may delete this language.

While your drinking water meets EPA's standard for arsenic, it does contain low levels of arsenic. EPA's standard balances the current understanding of arsenic's possible health effects against the costs of removing arsenic from drinking water. EPA continues to research the health effects of low levels of arsenic, which is a mineral known to cause cancer in humans at high concentrations and is linked to other health effects such as skin damage and circulatory problems.

If your system detected nitrate at levels above 5 mg/L, but below the MCL, include the following language. Otherwise, you may delete this language.

Nitrate in drinking water at levels above 10 ppm is a health risk for infants of less than six months of age. High nitrate levels in drinking water can cause blue baby syndrome. Nitrate levels may rise quickly for short periods of time because of rainfall or agricultural activity. If you are caring for an infant, you should ask advice from your health care provider.

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Synthetic Organic Contaminants including Pesticides and HerbicidesYou should add more rows to this table if you have more detections to report than there are rows.

Name of Organic Contaminant Collection Date

If sampling

takes place

once per year or

less, Highest Level

Detected

or

If sampling

takes place more than

once per year at each

sampling point,

Average Level

Detected at the

Sampling Point

with the

Range of Levels

Detected

MCLG MCL(unless

treatment

technique or action level is

specified)

Unit of MCLG

and MCL

Was This a Violation?

Likely Source of ContaminationIn this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed below.

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Highest Average Level of

All Sampling

Points2,4-D 70 70 ppb Runoff from herbicide used on row

crops.2,4,5-TP (Silvex) 50 50 ppb Residue of banned herbicide.

Acrylamide 0 Treatment technique:

NA Added to water during sewage/wastewater treatment.

Alachlor 0 2 ppb Runoff from herbicide used on row crops.

Atrazine 3 3 ppb Runoff from herbicide used on row crops.

Benzo(a)pyrene (PAH) 0 200 ppt Leaching from linings of water storage tanks and distribution lines.

Carbofuran 40 40 ppb Leaching of soil fumigant used on rice and alfalfa.

Chlordane 0 2 ppb Residue of banned termiticide.

Dalapon 200 200 ppb Runoff from herbicide used on rights of way.

Di(2-ethylhexyl)adipate 400 400 ppb Discharge from chemical factories.

Di(2-ethylhexyl)phthalate 0 6 ppb Discharge from rubber and chemical factories.

Dibromochloropropane 0 200 ppt Runoff/leaching from soil fumigant used on soybeans, cotton, pineapples,

and orchards.Dinoseb 7 7 ppb Runoff from herbicide used on

soybeans and vegetables.Diquat 20 20 ppb Runoff from herbicide use.

Dioxin (2,3,7,8-TCDD) 0 30 ppq Emissions from waste incineration and other combustion; Discharge from

chemical factories.Endothall 100 100 ppb Runoff from herbicide use.

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Endrin 2 2 ppb Residue of banned insecticide.

Epichlorohydrin 0 Treatment technique:

N/A Discharge from industrial chemical factories; An impurity of some water

treatment chemicals.Ethylene dibromide 0 50 ppt Discharge from petroleum refineries.

Glyphosate 700 700 ppb Runoff from herbicide use.

Heptachlor 0 400 ppt Residue of banned termiticide.

Heptachlor epoxide 0 200 ppt Breakdown of heptachlor.

Hexachlorobenzene 0 1 ppb Discharge from metal refineries and agricultural chemical factories.

Hexachlorocyclopentadiene 50 50 ppb Discharge from chemical factories.

Lindane 200 200 ppt Runoff/leaching from insecticide used on cattle, lumber, gardens.

Methoxychlor 40 40 ppb Runoff/leaching from insecticide used on fruits, vegetables, alfalfa, livestock.

Oxamyl (Vydate) 200 200 ppb Runoff/leaching from insecticide used on apples, potatoes, and tomatoes.

PCBs (Polychlorinated biphenyls) 0 500 ppt Runoff from landfills; Discharge of waste chemicals.

Pentachlorophenol 0 1 ppb Discharge from wood preserving factories.

Picloram 500 500 ppb Herbicide runoff.

Simazine 4 4 ppb Herbicide runoff.

Toxaphene 0 3 ppb Runoff/leaching from insecticide used on cotton and cattle.

Volatile Organic ContaminantsYou should add more rows to this table if you have more detections to report than there are rows.

Name of Organic Contaminant

Collection Date

If sampling

takes

Range of Levels

Detected

MCLG MCL(unless

treatment

Unit of MCLG and

MCL

Was This a Violation?

Likely Source of Contamination

In this column, you are

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place once per year or less, Highest Level

Detected

or

If sampling

takes place

more than once per year at each

sampling point,

Average Level

Detected at the

Sampling Point with

the Highest Average Level of

All Sampling

Points

technique or action level is specified)

only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed below.

Benzene 0 5 ppb Discharge from factories; Leaching from gas storage

tanks and landfills.

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Carbon tetrachloride 0 5 ppb Discharge from chemical plants and other industrial

activities.Chlorobenzene 100 100 ppb Discharge from chemical and

agricultural chemical factories.

o-Dichlorobenzene 600 600 ppb Discharge from industrial chemical factories.

p-Dichlorobenzene 75 75 ppb Discharge from industrial chemical factories.

1,2-Dichloroethane 0 5 ppb Discharge from industrial chemical factories.

1,1-Dichloroethylene 7 7 ppb Discharge from industrial chemical factories.

Cis-1,2-Dichloroethylene 70 70 ppb Discharge from industrial chemical factories.

Trans-1,2-Dichloroethylene 100 100 ppb Discharge from industrial chemical factories.

Dichloromethane 0 5 ppb Discharge from pharmaceutical and chemical

factories.1,2-Dichloropropane 0 5 ppb Discharge from industrial

chemical factories.Ethylbenzene 700 700 ppb Discharge from petroleum

refineries.Styrene 100 100 ppb Discharge from rubber and

plastic factories; Leaching from landfills.

Tetrachloroethylene 0 5 ppb Leaching from PVC pipes; Discharge from factories and

dry cleaners.1,2,4-Trichlorobenzene 70 70 ppb Discharge from textile

finishing factories.1,1,1-Trichloroethane 200 200 ppb Discharge from metal

degreasing sites and other factories.

1,1,2-Trichloroethane 3 5 ppb Discharge from industrial chemical factories.

Trichloroethylene 0 5 ppb Discharge from metal

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degreasing sites and other factories.

Toluene 1 1 ppm Discharge from petroleum factories.

Vinyl Chloride 0 2 ppb Leaching from PVC piping; Discharge from plastics

factories.Xylenes 10 10 ppm Discharge from petroleum

factories; Discharge from chemical factories.

Lead and CopperYou should add more rows to this table if you have more detections to report than there are rows.

Lead or Copper Year The 90th

Percentile Value of the Most Recent

Round of Sampling

Number of Sites Exceeding Action

Level

Action Level Unit of Measure

Was This a Violation?

Source of Contaminant

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information

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on the likely source, you must include one or more of the typical sources listed below.

Lead 15 ppb Corrosion of household plumbing systems; Erosion of natural

deposits.Copper 1.3 ppm Corrosion of household

plumbing systems; Erosion of natural

deposits.

If your system collected 20 or more samples that detected lead above the action level in greater than 5.0% of homes sampled, include the following language. Otherwise, you may delete this language.

Infants and young children are typically more vulnerable to lead in drinking water than the general population. It is possible that lead levels at your home may be higher than at the homes in the community as a result of materials used in your home's plumbing. If you are concerned about elevated lead levels in your home's water, you may wish to have your water tested and flush your tap for 30 seconds to two minutes before using tap water. Additional information is available from the Safe Drinking Water Hotline at (800) 426-4791.

Disinfectants and Disinfection By-Products

You should add more rows to this table if you have more detections to report than there are rows.

If you detected total trihalomethanes above 0.080 mg/L as a running annual average, you are required to include the following language. Otherwise, you may delete the following language:

Some people who drink water containing trihalomethanes in excess of the MCL over many years may experience problems with their liver, kidneys, or central nervous systems, and may have an increased risk of getting cancer.

Name of Collection If If no Range of Levels MCLG MCL Units Was This Likely Source of Contamination

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Disinfectants and

Disinfection By-Products Date

sampling takes place once per year or

less, Highest Level

Detected

or

If sampling

takes place more than once per year at each

sampling point,

Average Level

Detected at the

Sampling Point with the Highest

Average Level of All Sampling

Points

location or one

location exceeds

the MCL, Highest

Locational Running Annual Average

Or, if more than

one location exceeds

the MCL, Locational Running Annual

Averages for All

Sampling Points that Exceed the

MCL

Detecteda

Violation?

In this column, you are only required to include information if a detection of the row’s contaminant is listed. In that case, you are required to include information on the likely source(s) of detected contaminants based on your operator’s knowledge. If your operator lacks specific information on the likely source, you must include one or more of the typical sources listed below.

Chloramines N/A MRDLG=4

MRDL=4

ppm Water additive used to control microbes.

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Chlorine N/A MRDLG=4

MRDL=4

ppm Water additive used to control microbes.

Chlorine Dioxide

N/A MRDLG=800

MRDL=800

ppb Water additive used to control microbes.

Haloacetic acids n/a 60 ppb By-product of drinking water disinfection.

TTHMs (Total trihalomethanes)

n/a 80 ppb By-product of drinking water disinfection.

Cryposporidium

Summary of the Results of Any Detections Explanation of the Significance of the Results

If you have done any monitoring for Cryptosporidium, you must include and fill out this table. Otherwise, you many delete this table. You should add more rows to this table if you have more detections to report than there are rows.

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Radon If you have done any monitoring for radon which indicates that radon may be present in the finished water, you must include and fill out this table. Otherwise, you many delete this table.

You should add more rows to this table if you have more detections to report than there are rows.

Results of the Monitoring Explanation of the Significance of the Results

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Violations that Occurred in insert the year the report covers

If you did not have a violation for a contaminant or issue listed below, you can delete its row.

Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

Microbiological ContaminantsTotal coliform Coliforms are bacteria that are naturally

present in the environment and are used as an indicator that other, potentially-harmful, bacteria may be present. Coliforms were found in more samples than allowed and this was a warning of potential problems.

Fecal coliform/E.coli

Fecal coliforms and E. coli are bacteria whose presence indicates that the water

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

may be contaminated with human or animal wastes. Microbes in these wastes can cause short-term effects, such as diarrhea, cramps, nausea, headaches, or other symptoms. They may pose a special health risk for infants, young children, and people with severely compromised immune systems.

Fecal indicators (enterococci or

coliphage)

Fecal indicators are microbes whose presence indicates that the water may be contaminated with human or animal wastes. Microbes in these wastes can cause short-term health effects, such as diarrhea, cramps, nausea, headaches, or other symptoms. They may pose a special health risk for infants, young children, some of the elderly, and people with severely compromised immune systems.

Total organic carbon Total organic carbon (TOC) has no health affects. However, TOC provides a medium for the formation of disinfection by-products. These by-products include trihalomethanes (THMs) and haloacetic acids (HAAs). Drinking water containing these by-products in excess of the maximum contaminant level

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

(MCL) may lead to adverse health effects, liver or kidney problems, or nervous system effects, and may lead to an increased risk of getting cancer.

Turbidity Turbidity has no health effects. However, turbidity can interfere with disinfection and provide a medium for microbial growth. Turbidity may indicate the presence of disease-causing organisms. These organisms include bacteria, viruses, and parasites that can cause symptoms such as nausea, cramps, diarrhea, and associated headaches.

Radioactive Contaminants

Beta/photon emitters Certain minerals are radioactive and may emit forms of radiation known as photons and beta radiation. Some people who drink water containing beta and photon emitters in excess of the MCL over many years may have an increased risk of getting cancer.

Alpha emitters Certain minerals are radioactive and may emit a form of radiation known as alpha radiation. Some people who drink water containing alpha emitters in

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

excess of the MCL over many years may have an increased risk of getting cancer.

Combined Radium 226/228

Some people who drink water containing radium 226 or 228 in excess of the MCL over many years may have an increased risk of getting cancer.

Uranium Some people who drink water containing uranium in excess of the MCL over many years may have an increased risk of getting cancer and kidney toxicity.

Inorganic Contaminants

Antimony Some people who drink water containing antimony well in excess of the MCL over many years could experience increases in blood cholesterol and decreases in blood sugar.

Arsenic Some people who drink water containing arsenic in excess of the MCL over many years could experience skin damage or problems with their circulatory system, and may have an increased risk of getting cancer.

Asbestos Some people who drink water containing asbestos in excess of the

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

MCL over many years may have an increased risk of developing benign intestinal polyps.

Barium Some people who drink water containing barium in excess of the MCL over many years could experience an increase in their blood pressure.

Beryllium Some people who drink water containing beryllium well in excess of the MCL over many years could develop intestinal lesions.

Bromate Some people who drink water containing bromate in excess of the MCL over many years could experience an increased risk of getting cancer.

Cadmium Some people who drink water containing cadmium in excess of the MCL over many years could experience kidney damage.

Chloramines Some people who use water containing chloramines well in excess of the MRDL could experience irritating effects to their eyes and nose. Some people who drink water containing chloramines well in excess of the maximum residual disinfectant level (MRDL) could experience stomach

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

discomfort or anemia.Chlorine Some people who use water containing

chlorine well in excess of the MRDL could experience irritating effects to

their eyes and nose. Some people who drink water containing chlorine well in excess of the MRDL could experience

stomach discomfort.Chlorine dioxide Some infants and young children who

drink water containing chlorine dioxide in excess of the MRDL could experience nervous system effects. Similar effects may occur in fetuses of pregnant women who drink water containing chlorine dioxide in excess of the MRDL. Some people may experience anemia.

Chlorite Some infants and young children who drink water containing chlorite in excess of the MCL could experience nervous system effects. Similar effects may occur in fetuses of pregnant women who drink water containing chlorite in excess of the MCL. Some people may experience anemia.

Chromium Some people who use water containing chromium well in excess of the MCL

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

over many years could experience allergic dermatitis.

Copper Copper is an essential nutrient, but some people who drink water containing copper in excess of the action level over a relatively short amount of time could experience gastrointestinal distress. Some people who drink water containing copper in excess of the action level over many years could suffer liver or kidney damage. People with Wilson's Disease should consult their personal doctor.

Cyanide Some people who drink water containing cyanide well in excess of the MCL over many years could experience nerve damage or problems with their thyroid.

Fluoride Some people who drink water containing fluoride in excess of the MCL over many years could get bone disease, including pain and tenderness of the bones. Children may get mottled teeth.

Lead Infants and children who drink water containing lead in excess of the action level could experience delays in their

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

physical or mental development. Children could show slight deficits in attention span and learning abilities. Adults who drink this water over many years could develop kidney problems or high blood pressure.

Mercury (inorganic).

Some people who drink water containing inorganic mercury well in excess of the MCL over many years could experience kidney damage.

Nitrate Infants below the age of six months who drink water containing nitrate in excess of the MCL could become seriously ill and, if untreated, may die. Symptoms include shortness of breath and blue-baby syndrome.

Nitrite Infants below the age of six months who drink water containing nitrite in excess of the MCL could become seriously ill and, if untreated, may die. Symptoms include shortness of breath and blue-baby syndrome.

Selenium Selenium is an essential nutrient. However, some people who drink water containing selenium in excess of the MCL over many years could experience hair or fingernail losses, numbness in

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

fingers or toes, or problems with their circulation.

Thallium Some people who drink water containing thallium in excess of the MCL over many years could experience hair loss, changes in their blood, or problems with their kidneys, intestines, or liver.

Synthetic Organic Contaminants

Including Pesticides and Herbicides

2,4-D Some people who drink water containing the weed killer 2,4-D well in excess of the MCL over many years could experience problems with their kidneys, liver, or adrenal glands.

2,4,5-TP (Silvex) Some people who drink water containing silvex in excess of the MCL over many years could experience liver problems.

Acrylamide Some people who drink water containing high levels of acrylamide over a long period of time could have problems with their nervous system or blood, and may have an increased risk of getting cancer.

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

Alachlor Some people who drink water containing alachlor in excess of the MCL over many years could have problems with their eyes, liver, kidneys, or spleen, or experience anemia, and may have an increased risk of getting cancer.

Atrazine Some people who drink water containing atrazine well in excess of the MCL over many years could experience problems with their cardiovascular system or reproductive difficulties.

Benzo(a)pyrene (PAH)

Some people who drink water containing benzo(a)pyrene in excess of the MCL over many years may experience reproductive difficulties and may have an increased risk of getting cancer.

Carbofuran Some people who drink water containing carbofuran in excess of the MCL over many years could experience problems with their blood, or nervous or reproductive systems.

Chlordane Some people who drink water containing chlordane in excess of the MCL over many years could experience problems with their liver or nervous

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

system, and may have an increased risk of getting cancer.

Dalapon Some people who drink water containing dalapon well in excess of the MCL over many years could experience minor kidney changes.

Di (2-ethylhexyl) adipate

Some people who drink water containing di (2-ethylhexyl) adipate well in excess of the MCL over many years could experience general toxic effects such as weight loss, liver enlargement, or possible reproductive difficulties.

Di (2-ethylhexyl) phthalate

Some people who drink water containing di (2-ethylhexyl) phthalate in excess of the MCL over many years may have problems with their liver, or experience reproductive difficulties, and may have an increased risk of getting cancer.

Dibromochloropropane (DBCP)

Some people who drink water containing DBCP in excess of the MCL over many years could experience reproductive difficulties and may have an increased risk of getting cancer.

Dinoseb Some people who drink water containing dinoseb well in excess of the MCL over many years could experience

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

reproductive difficulties.Dioxin (2,3,7,8-

TCDD)Some people who drink water containing dioxin in excess of the MCL over many years could experience reproductive difficulties and may have an increased risk of getting cancer.

Diquat Some people who drink water containing diquat in excess of the MCL over many years could get cataracts.

Endothall Some people who drink water containing endothall in excess of the MCL over many years could experience problems with their stomach or intestines.

Endrin Some people who drink water containing endrin in excess of the MCL over many years could experience liver problems.

Epichlorohydrin Some people who drink water containing high levels of epichlorohydrin over a long period of time could experience stomach problems, and may have an increased risk of getting cancer.

Ethylene dibromide Some people who drink water containing ethylene dibromide in excess of the MCL over many years could

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

experience problems with their liver, stomach, reproductive system, or kidneys, and may have an increased risk of getting cancer.

Glyphosate Some people who drink water containing glyphosate in excess of the MCL over many years could experience problems with their kidneys or reproductive difficulties.

Heptachlor Some people who drink water containing heptachlor in excess of the MCL over many years could experience liver damage and may have an increased risk of getting cancer.

Hexachlorobenzene Some people who drink water containing hexachlorobenzene in excess of the MCL over many years could experience problems with their liver or kidneys, or adverse reproductive effects, and may have an increased risk of getting cancer.

Hexachlorocyclopentadiene

Some people who drink water containing hexachlorocyclopentadiene well in excess of the MCL over many years could experience problems with their kidneys or stomach.

Lindane Some people who drink water

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

containing lindane in excess of the MCL over many years could experience problems with their kidneys or liver.

Methoxychlor Some people who drink water containing methoxychlor in excess of the MCL over many years could experience reproductive difficulties.

Oxamyl Some people who drink water containing oxamyl in excess of the MCL over many years could experience slight nervous system effects.

PCBs Some people who drink water containing PCBs in excess of the MCL over many years could experience changes in their skin, problems with their thymus gland, immune deficiencies, or reproductive or nervous system difficulties, and may have an increased risk of getting cancer.

Pentachlorophenol Some people who drink water containing pentachlorophenol in excess of the MCL over many years could experience problems with their liver or kidneys, and may have an increased risk of getting cancer.

Picloram Some people who drink water containing picloram in excess of the

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

MCL over many years could experience problems with their liver.

Simazine Some people who drink water containing simazine in excess of the MCL over many years could experience problems with their blood.

Toxaphene Some people who drink water containing toxaphene in excess of the MCL over many years could have problems with their kidneys, liver, or thyroid, and may have an increased risk of getting cancer.

Volatile Organic Contaminants

Benzene Some people who drink water containing benzene in excess of the MCL over many years could experience anemia or a decrease in blood platelets, and may have an increased risk of getting cancer.

Carbon Tetrachloride

Some people who drink water containing carbon tetrachloride in excess of the MCL over many years could experience problems with their liver and may have an increased risk of getting

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

cancer.Chlorobenzene Some people who drink water

containing chlorobenzene in excess of the MCL over many years could experience problems with their liver or kidneys.

o-Dichlorobenzene Some people who drink water containing o-dichlorobenzene well in excess of the MCL over many years could experience problems with their liver, kidneys, or circulatory systems.

p-Dichlorobenzene Some people who drink water containing p-dichlorobenzene in excess of the MCL over many years could experience anemia, damage to their liver, kidneys, or spleen, or changes in their blood.

1,2-Dichloroethane Some people who drink water containing 1,2-dichloroethane in excess of the MCL over many years may have an increased risk of getting cancer.

1,1-Dichloroethylene

Some people who drink water containing 1,1-dichloroethylene in excess of the MCL over many years could experience problems with their liver.

cis-1,2- Some people who drink water

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

Dichloroethylene containing cis-1,2-dichloroethylene in excess of the MCL over many years could experience problems with their liver.

trans-1,2-Dicholoroethylene

Some people who drink water containing trans-1,2-dichloroethylene well in excess of the MCL over many years could experience problems with their liver.

Dichloromethane Some people who drink water containing dichloromethane in excess of the MCL over many years could have liver problems and may have an increased risk of getting cancer.

1,2-Dichloropropane Some people who drink water containing 1,2-dichloropropane in excess of the MCL over many years may have an increased risk of getting cancer.

Ethylbenzene Ethylbenzene. Some people who drink water containing ethylbenzene well in excess of the MCL over many years could experience problems with their liver or kidneys.

Haloacetic acids (HAAs)

Haloacetic acids (HAAs). Some people who drink water containing HAAs in

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

excess of the MCL over many years may have an increased risk of getting cancer.

Styrene Some people who drink water containing styrene well in excess of the MCL over many years could have problems with their liver, kidneys, or circulatory system.

Tetrachloroethylene Some people who drink water containing tetrachloroethylene in excess of the MCL over many years could have problems with their liver, and may have an increased risk of getting cancer.

1,2,4-Trichlorobenzene.

Some people who drink water containing 1,2,4-trichlorobenzene well in excess of the MCL over many years could experience changes in their adrenal glands.

1,1,1,-Trichloroethane

Some people who drink water containing 1,1,1-trichloroethane in excess of the MCL over many years could experience problems with their liver, nervous system, or circulatory system.

1,1,2-Trichloroethane

Some people who drink water containing 1,1,2-trichloroethane well in excess of the MCL over many years could have problems with their liver,

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

kidneys, or immune systems.Trichloroethylene Some people who drink water

containing trichloroethylene in excess of the MCL over many years could experience problems with their liver and may have an increased risk of getting cancer.

TTHMs (Total Trihalomethanes)

Some people who drink water containing trihalomethanes in excess of the MCL over many years may experience problems with their liver, kidneys, or central nervous systems, and may have an increased risk of getting cancer.

Toluene Some people who drink water containing toluene well in excess of the MCL over many years could have problems with their nervous system, kidneys, or liver.

Vinyl Chloride Some people who drink water containing vinyl chloride in excess of the MCL over many years may have an increased risk of getting cancer.

Xylenes Some people who drink water containing xylenes in excess of the MCL over many years could experience damage to their nervous system.

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

Monitoring and reporting of

compliance dataFiltration and disinfection

Inadequately treated water may contain disease-causing organisms. These organisms include bacteria, viruses, and parasites that can cause symptoms such as nausea, cramps, diarrhea, and associated headaches.

Lead and copper control requirements

(as set in Title 30 of the Texas Administrative Code Section

290.117)

If you did not take one or more actions in Title 30 of the Texas Administrative Code Sections 290.117(g), (h), and (i) include the following language as applicable (that is, the language for copper, lead, or both). Copper is an essential nutrient, but some people who drink water containing copper in excess of the action level over a relatively short amount of time could experience gastrointestinal distress. Some people who drink water containing copper in excess of the action level over many years could suffer liver or kidney damage. People with Wilson's

If you did not take one or more actions in Title 30 of the Texas Administrative Code Sections 290.117(g), (h), and (i) include the steps taken to correct the violation(s).

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

Disease should consult their personal doctor.

Infants and children who drink water containing lead in excess of the action level could experience delays in their physical or mental development. Children could show slight deficits in attention span and learning abilities. Adults who drink this water over many years could develop kidney problems or high blood pressure.

Treatment techniques for

Acrylamide and Epichlorohydrin(as set in Title 30 of the Texas Administrative Code Section

290.107)

Some people who drink water containing high levels of acrylamide over a long period of time could have problems with their nervous system or blood, and may have an increased risk of getting cancer.

Some people who drink water containing high levels of epichlorohydrin over a long period of time could experience stomach problems, and may have an increased risk of getting cancer.

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Contaminant or Issue the

Violation is Related to

Violation Type

(clear and readily understandable)

Explanation of the Violation

Date of Violation

Date Violation Resolved

Potential Adverse Health EffectsYou have to use the language

listed in this column if you had a violation for the corresponding contaminant or issue. You have to include your own language on

potential health effects for contaminants or issues with language not listed in this

column, if you had a violation for that contaminant or issue.

Steps Taken to Correct the Violation

Recordkeeping of compliance data

Special monitoring requirements for

unregulated contaminants (as set in 40 CFR Section

141.40)Special monitoring requirements for

sodium ((as set in 40 CFR Section

141.41)Terms of a variance,

exemption, administrative order,

or judicial order

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Variances and Exemptions If your system is operating under a variance or exemption under 30 Texas Administrative Code Section 290.201(b), you need to include and fill out this table. Otherwise, you many delete this table.

You should add more rows to this table if you have more variances or exemptions to report than there are rows.

Variance or

Exemption Explanation of the Variance or Exemption

Date the Variance

or Exemption

Was Issued

Date the Variance

or Exemption

ExpiresBrief Status on the Steps the System is Taking to Comply with the Terms and

Schedules of the Variance or Exemption

Any Opportunity for Public Input on the Review or Renewal of the Variance or

Exemption

Interconnects or Emergency SourcesIf you used an interconnect or emergency source to augment your drinking water supply during the year this report covers, provide the following information. Otherwise, you may delete this table.

You should add more rows to this table if you have more interconnects or emergency sources to report than there are rows.

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Source of the Water Length of Time Used

Explanation of Why It Was Used Whom to Call for the Water Quality Information

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