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Iowa DNR Public Water Supply Report forms
Listed below are the monthly operation report templates, sampling plan templates, and other forms and guidance documents used by public water supplies to report information to Iowa DNR's Water Supply Operation Section and Environmental Field Offices. Several of the forms and templates are based upon the population served in the system and the source water type: groundwater (GW), surface water (SW), or groundwater under the direct influence of surface water (also called influenced groundwater, or IGW).
Back to topInstrumentation Data Integrity Forms
- 542-1072 Instrumentation Data Integrity Checklist (Portable Colorimeter) (184.96 KB) .pdf
- 542-1073 Instrumentation Data Integrity Checklist (Online DPD Colorimetric Chlorine Analyzer) (367.19 KB) .pdf
- 542-1074 Instrumentation Data Integrity Checklist (549.01 KB) .pdf
Other Iowa DNR Public Water Supply Report forms
- Iowa Online Turbidimeter Calibration and Verification Guidance Document (287.9 KB) .pdf
- Iowa Underwater Storage Tank Inspection and Cleaning Guidance Document (703.13 KB) .pdf
- Iowa Emergency Provision of Water: Transport and Safety (Water Hauling) (2.06 MB) .pdf
Lead and Copper Sampling Plan:
Each community public water supply and non-transient non-community public water supply system must comply with the Lead and Copper Rule. A sampling plan is required that identifies the exact location of each sampling site. Sampling sites are based upon plumbing materials both in the service lines and within the building. The Customer Questionnaire is a survey tool that can be used by the homeowner to assist the water supply in determining what types of plumbing materials have been used in its system. The Lead and Copper Rule sampling plan template includes the required plan elements, as well as descriptions of the three Tier levels, how to properly collect samples, etc. Both documents are available in fillable .pdf and .doc formats. The plan is also available in a modifiable MS-Word format, upon request from the Water Supply Operations Section or the Field Office.
Lead and Copper Sampling Documents
- Lead and Copper Sampling Plan (542-0357) (1.44 MB) .pdf
- Lead and Copper Rule: Change of Sample Site (542-0643) (1.28 MB) .pdf
- Customer Questionnaire for Lead and Copper Testing of Drinking Water (542-0385) (1.12 MB) .pdf
Stage 2 DBPR Sampling Plans:
Listed below are templates for Stage 2 Disinfectant/Disinfection Byproducts Rule sampling plans, by source water type and population. The templates are available in fillable .pdf and .doc formats.
- Stage 2 DBPR groundwater system serving 25-9,999 people monitoring plan (542-0458) (868.57 KB) .pdf
- Stage 2 DBPR groundwater system serving 10,000-99,999 people monitoring plan (542-0459 (950 KB) .pdf
- Stage 2 DBPR surface water or IGW system serving 25-499 people monitoring plan (542-0460) (865.89 KB) .pdf
- Stage 2 DBPR surface water or IGW system serving 500-3,300 people monitoring plan (542-0461) (873.06 KB) .pdf
- Stage 2 DBPR surface water or IGW system serving 3,301-9,999 people monitoring plan (542-0462) (873.09 KB) .pdf
- Stage 2 DBPR surface water or IGW system serving 10,000-49,999 people monitoring plan (542-0463) (875.34 KB) .pdf
- Stage 2 DBPR surface water or IGW system serving 50,000-249,999 people monitoring plan (542-0464) (884.87 KB) .pdf
- Stage 2 DBPR - Change of Sampling Site form (542-0465) (1.03 MB) .pdf
- Stage 2 DBPR - Operational Evaluation Level Report Form (542-0554) (922.61 KB) .pdf
Revised Total Coliform Bacteria Rule and Groundwater Rule Sampling Plans
Listed below are templates for revised total coliform bacteria sampling plans, which also include the groundwater rule sampling plan requirements when indicated. The templates are available in fillable .pdf and .doc formats. The plans are also available in a modifiable MS-Word format, upon request from the Water Supply Operations Section or the Field Office.
- RTCR-GWR Sampling Plan for Groundwater PWS collecting one bacteria sample per quarter (542-0724) (1.31 MB) .pdf
- RTCR-GWR Sampling Plan for Groundwater PWS collecting one bacteria sample per month (542-0467) (1.13 MB) .pdf
- RTCR-GWR Sampling Plan for Groundwater PWS collecting 2 or more bacteria samples per month (542-0457) (1.34 MB) .pdf
- RTCR Sampling Plan for SW/IGW PWS collecting 2 or more bacteria samples per month (542-0896) (1.25 MB) .pdf
- RTCR Sampling Plan for Consecutive SW/IGW PWS collecting 1 bacteria sample per month (542-0859) (1.23 MB) .pdf
Nitrite Sampling Plans
Listed below are templates for nitrite sampling plans for systems on an annual or quarterly sampling frequency. The templates are available in fillable .pdf and .doc formats. The plans are also available in a modifiable MS-Word format, upon request from the Water Supply Operations Section or the Field Office.
- Nitrite Sampling Plan for Annual Sampling (542-0919) (1.06 MB) .pdf
- Nitrite Sampling Plan for Quarterly Sampling (542-0920) (1.06 MB) .pdf