The forms used by the Department in the Public Water System
Supervision Program are listed below by form number and name. Each form has
been incorporated into the rule that references it. Copies of these forms may
be obtained by writing to the Department of Environmental Protection, Source
and Drinking Water Program, M.S. 3520, 2600 Blair Stone Road, Tallahassee,
Florida 32399-2400. In addition, these forms are available at the Department of
Environmental Protection's district offices, at the Approved County Health
Departments, and on the Department of Environmental Protection's web site at
www.dep.state.fl.us. Persons and
public water systems shall report to the Department using the forms listed
below or using computer-generated versions of the forms listed below provided
such versions are identical to the forms listed below in every respect other
than font type and style, font size, and character spacing.
(1) Application for a Specific Permit to
Construct PWS Components, effective August 28, 2003.
(2) Monthly Operation Report for Subpart H
Systems, effective October 14, 2004.
(3) Monthly Operation Report for PWSs
Treating Raw Ground Water or Purchased Finished Water, effective August 28,
2003.
(4) Monthly Operation Report
for Consecutive Systems that Do Not Treat Water, effective August 28,
2003.
(5) Monthly Operation Report
for PWSs Fluoridating Water, effective August 28, 2003.
(6) Monthly Operation Report for Consecutive
Systems that Receive Purchased Finished Water from a Subpart H System,
effective April 3, 2003.
(7) Notice
of Intent to Use the General Permit for Construction of Water Main Extensions
for PWSs, effective August 28, 2003.
(8) Application for Transfer of a PWS
Construction Permit, effective August 28, 2003.
(9) Certification of Construction Completion
and Request for Clearance to Place Permitted PWS Components into Operation,
effective August 28, 2003.
(10)
Asbestos-Free Certification or Asbestos Sampling Plan for PWSs, effective
August 28, 2003.
(11) Monthly
Operation Report for Summation of Finished-Water Production by CWSs that Have
Multiple Treatment Plants, effective August 28, 2003.
(12) PWS Sampling Plan for Lead and Copper
Tap Samples and Water Quality Parameters, effective August 28, 2003.
(13) Form
62-555.900(13),
Cross-Connection Control Program Annual Report, effective 5-5-14, incorporated
by reference in paragraph
62-555.360(2)(b),
F.A.C.
(14) Deleted.
(15) Deleted.
(16) PWS Certification of Notification of
Lead and Copper Tap Sample Results, effective October 1, 2010.
(17) Lead Public Education Program Report for
PWSs, effective October 1, 2010.
(18) Notice of Intent to Use the General
Permit for Construction of Lead or Copper Corrosion Control, or Iron or
Manganese Sequestration, Treatment Facilities for Small or Medium PWSs,
effective August 28, 2003.
(19)
Form number
62-555.900(19),
Certification of Delivery of Consumer Confidence Report, effective April 10,
2003.
(20) New Water System
Capacity Development Financial and Managerial Operations Plan, effective August
28, 2003.
(21) Form number
62-555.900(21),
Certification of Delivery of Consumer Confidence Information to Supplied
Systems, effective April 10, 2003.
(22) Form number
62-555.900(22),
Certification of Delivery of Public Notice, effective
1-17-05.
