Drinking Water Treatment Plants

Questionnaire for

Volunteer Drinking Water Utilities Participating in Emerging Contaminant Sampling Program

EPA ICR No. 2346.01, OMB Control No. 2080-NEW

Thank you for volunteering to participate in the Emerging Contaminant Sampling Program. The information gathered on the following questionnaire will be used by the US Environmental Protection Agency’s Office of Research and Development to better interpret the results of the sampling project. Please complete and return the questionnaire as soon as possible after sampling. Electronic submissions are preferred, but paper submissions will be accepted. Submissions and questions should be directed to:

Susan T. Glassmeyer, Ph.D

US Environmental Protection Agency

26 W. Martin Luther King Dr

MS 564

Cincinnati, OH 45268

glassmeyer.susan@epa.gov

(p) 513-569-7526

6. 513-569-7757

Paperwork Reduction Act Notice

Part A. Contact Information

Facility Name

Water System ID

Date

Address

City

State

Zip

Contact person

Title

E-mail

Phone

Website

The public reporting and recordkeeping burden for this collection of information is estimated to average 20 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed survey to this address.

Part B. Location Information
City/region served
Population served
What source water(s) does the facility draw from? Provide both name of waterbody and nature of source water (river, lake reservoir, shallow well, deep well). If multiple water sources are used, provide percentage of total flow from each source.
For surface waters, is the source water currently low, average or high (in terms of flow and/or stage)? If actual measurements are available, please provide such measurements of discharge and/or stage of the source water at time of sampling.
Have the source and/or finished water ever been analyzed for emerging contaminants? If so, please supply analyte(s), measured concentration(s), analyst(s), and date of analysis.
How many and what type of wastewater outfalls are located within 25 miles upstream of the plant’s intake pipes? Can you provide a source for this information if you do not have it yourself?
How many and what type of industrial outfalls are located within 25 miles upstream of the plant’s intake pipes? Can you provide a source for this information if you do not have it yourself?
Is the source water impacted by agrichemicals (such as pesticides, fertilizers)?
After water leaves the clear well, is it blended with waters from other sources in your system? If so, describe the other source and typical blending composition or range of composition.
Is water from this plant’s distribution system sold to another utility’s system? If so, which system, and how much is provided?

Part C. Treatment Information
Plant age
Minimum, mean, and maximum daily pumpage (mgd)
Pumpage at sampling (mgd)
Ratio of domestic to industrial useage
Overall residence time from source water to finished water collection points (hours)
What treatment processes are employed in the plant? Include those processes that are intermittent or brought on line as needed. Please list them in order from raw to finished water. If treatment is split, indicate the processes on the parallel treatment trains. If multiple sources are used, please indicate the point at which each source is introduced into the treatment train. Include treatment that is simultaneous or concurrent; for example, PAC with coagulation/clarification, chlorine with filtration, etc.
In addition to the source (untreated) water and the clear well effluent (finished) water, after which processes can samples be collected?
For treatments that are intermittent or as needed, for what purpose are they brought online? For example, powdered activated carbon (PAC) for taste and odor control, chlorine for manganese control, copper sulfate for algal control, etc.
Is there a disinfectant residual present in the filter?
If PAC is used, what is its purpose? For example, taste and odor control. What brand and size of PAC is used? What is the estimated contact time?
For each PAC purpose, what dose is applied?
If GAC is used, what is its purpose? For example, taste and odor control, DBP precursor control. What brand of GAC is used?
How often is GAC replaced or reactivated?
On what basis is GAC replaced/reactivated? For example, chlorine breakthrough, TOC breakthrough, taste-and-odor breakthrough.
Describe how the GAC is used. For example, as a 12-inch cap over sand, in a post-filter contactor of 6-foot depth. At current flow, what is the empty bed contact time?
Is a disinfectant residual applied to the GAC?
If membranes are used, describe their type (MF, UF, NF, RO) and purpose. What brand of membrane is used?
For each disinfectant/oxidant, what is the dose at each application point? Include free chlorine, combined chlorine, chlorine dioxide, transferred ozone, and permanganate.
If chloramines are used, describe how they are produced. For example, preformed chloramine, chlorination of influent ammonia, free chlorine contact time followed by ammonia addition.
If the plant uses UV, describe its purpose. Give the dose in mJ/cm2.
If the plant uses advanced oxidation (ozone/H2O2, UV/H2O2, etc), describe its purpose. Give the dose of each (transferred ozone in mg/L, H2O2 in mg/L, UV in mJ/cm2).
What disinfectant residuals are in the clear well effluent (finished water)? For example, 2.4 mg/L free chlorine and 0.4 mg/L combined chlorine, 1.6 mg/L free chlorine and 0.5 mg/L chlorine dioxide, 2.6 mg/L free chlorine only, 2.2 mg/L combined chlorine only.
Which processes are used to achieve CT credit by disinfection?
Which processes are used to achieve CT credit by physical removal?

Part D. USEPA Sample Collection Form Please fill out on sampling day(s), one form for Source Water, one for Finished Water.
Station ID
Sample Location
Collection Date (YYYYMMDD)
Collection Start Time (HHMM)
Collection End Time (HHMM)
Water Quality Parameters
Temperature
pH
Specific Conductance
Turbidity
Other Parameters
USEPA Sample Log in
Date
Time
Condition

EPA ICR No. 2346.01, OMB Control No. 2080-NEW Page 7 of 7