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Checklist for Drinking Water Source Assessment Spring Data Sheet Mobile App

Public water systems can use the Checklist for Drinking Water Source Assessment Spring Data Sheet mobile app with a smartphone or tablet to inspect and document drinking water sources and risk ratings. The app information should be contained in the drinking water source assessment submittal. This app includes a detailed Checklist for Drinking Water Source Assessment Spring Data. The protection zone for groundwater sources are a set of three circles surrounding the source. (For springs and horizontal wells, if determined to be groundwater sources, the protection zones need not include those portions of the circles down gradient of the source.) The radius of the protection zone is determined in the Delineation section of the assessment and depends upon the aquifer material, well pumping rate, screened interval, and aquifer porosity. At the discretion of the regulatory agency, the water system may request that the regulatory agency prepare a map displaying the source and zones.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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Take a peek inside the Checklist for Drinking Water Source Assessment Spring Data Sheet Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Public water system:

  • Ico textbox

    ID No.

  • Ico textbox

    Name of source:

  • Ico textbox

    ID No.

  • Ico date

    Assessment date:

  • Ico textbox

    Assessment conducted by:

  • Ico textbox

    Water System Contact Name:

  • Ico textbox

    Phone #:

  • Ico multiline

    Water System Contact Address:

  • Ico statictext

    The following information should be contained in the drinking water source assessment submittal.

  • Ico checkbox

    Delineation of groundwater protection zones

  • Ico checkbox

    Possible Contaminating Activities (PCA) inventory form

  • Ico checkbox

    Assessment map with source location and protection zone

  • Ico checkbox

    Additional maps (optional) (e.

  • Ico checkbox

    Means of Public Availability of Report (indicate those that will be used)

  • Ico checkbox

    Notice in the Consumer Confidence Report* (minimum)

  • Ico checkbox

    Copy in regulatory agency (DHS or LPA) office (minimum)

  • Ico checkbox

    Copy in public water system office (recommended)

  • Ico checkbox

    Copy in public library/libraries

  • Ico textbox

    Internet (indicate Internet address: )

  • Ico textbox

    Other (describe)

  • Ico statictext

    *The CCR should indicate where customers can review the assessments.

  • Ico textbox

    System Name

  • Ico textbox

    System Number

  • Ico textbox

    Source of Information (DHS/County files, system, etc)

  • Ico textbox

    Organization Collecting Information (DHS, County, System, other)

  • Ico date

    Date Information Collected/Updated

  • Ico textbox

    Source Name

  • ...and More!

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