WATER POINT INSPECTION
YES
NO
11.
WATER STORAGE
a.
Tanks Level
b.
Safety Bottom Apron Used
c.
Open Top Tanks Covered
d.
Tanks Clean and Sanitary
e.
Capacity Sufficient for Issue
12.
WATER DISTRIBUTION
a.
Standpipe Hose 4 Ft. Above Ground
b.
Hose Nozzle Clean/Off Ground
c.
Operators Check Containers for Cleanliness
13.
RECORDS
a.
Production Log Maintained
b.
Distribution Log Maintained
c.
Blank Forms Sufficient
14.
SUPPLY STORAGE
a.
Fuel and Chemicals Sufficient
b.
Chemical Containers Labeled/Capped/Dry
c.
Activated Carbon & Calcium Hypochlorite Stored Separately
15.
PRODUCT WATER SAMPLE
a.
Chloride ( 600 mg/L )
b.
Chlorine Residual Adequate ( _____ ppm )
c.
Color ( 50 Units )
d.
e.
pH ( Between 5 and 9 Units )
f.
Sulfate ( 400 mg/L )
g.
TDS ( 1500 mg/L )
h.
Turbidity ( 5 NTU )
i.
Chemical Agents Present
j.
Radioactivity Present
k.
Coliforms ( 1/100 ml ); Results on DD Form 686
COMMENTS AND RECOMMENDATIONS:
PRINTED/TYPED NAME AND GRADE OF PVNTMED INSPECTOR:
SIGNATURE:
DA FORM 5456-R, OCT 85
Figure 1-8. Sample of DA Form 5456-R (back).
1-19
QM 4923
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