Free New CFE eForm (ICPR Format) (95 - Indiana

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CF E

IE/LT1 SWTR COMBINED FILTER EFFLUENT TURBIDITY
State Form 53294 (6-07)

Indiana Department of Environmental Management (IDEM) Office of Water Quality - Drinking Water Branch - Compliance Section INSTRUCTIONS: Please submit completed forms to: IDEM OWQ Drinking Water, Mail Code 66-34, 100 N Senate Ave, Indianapolis, IN 46204-2251 System Name: PWSID:

I N
Plant Number:
This form must be completed and submitted to IDEM within the first ten (10) days after the end of the monitoring period in which the samples were collected. Hours of Operation Raw Water Turbidity

Plant Name:

Monitoring Period (MM/DD/YYYY):

/ 01 / 20
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Date:

Please submit completed form to: IDEM OWQ - Drinking Water Branch 100 N Senate Avenue Indianapolis, IN 46204-2251 Number >0.3 NTU

Day

Record Combined Effluent Turbidity Every Four Hours on a Daily Basis 1st 2nd 3rd 4th 5th 6th

Daily Max

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Reviewed by:

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I hereby certify that all the information submitted herein is true and accurate to the best of my knowledge. Completed By: