Spreadsheet: 19bf64bb-1cc2-4f82-8868-9cd39e67c97a
Sheet: Sheet1

Unnamed: 0 | FILTER ASSESSMENT REPORT FOR INDIVIDUAL FILTERS | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28
 | FOR PUBLIC WATER SYSTEMS THAT ARE USING SURFACE WATER SOURCES OR GROUND WATER SOURCES UNDER
 | THE INFLUENCE OF SURFACE WATER THAT ARE REQUIRED TO CONDUCT AN INDIVIDUAL FILTER ASSSESSMENT
 | PUBLIC WATER |  |  |  |  |  |  |  | PLANT NAME
 | SYSTEM NAME: |  |  |  |  |  |  |  | OR NUMBER:
 |  |  |  |  |  |  |  |  | FILTER
 | PWS ID No.: |  |  |  |  |  |  |  | NUMBER: |  |  |  |  |  |  |  | FILTER TYPE |  |  | OPERATING MODE |  |  |  | MEDIA TYPE |  |  | MEDIA MATERIAL
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Gravity |  |  | Constant Rate/Constant Level |  |  |  | Multiple Media |  |  | Anthracite
 |  |  |  |  | DESIGN SPECIFICATIONS |  |  |  |  |  |  |  |  |  |  |  | Pressure |  |  | Constant Rate/Variable Level |  |  |  | Dual Media |  |  | Sand
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Permutit |  |  | Declining Rate |  |  |  | Rapid Sand |  |  | Garnet
 | FILTER TYPE |  |  |  |  |  | OPERATING MODE |  |  |  |  |  |  |  |  |  | Other |  |  | Other |  |  |  | Deep-bed Mono Media |  |  | GAC
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other |  |  | Other
 |  |  | Diameter (ft) |  | Length (ft) |  | [NAME] (ft) | Surface Area (ft2) |  | [NAME] (ft) | [NAME] (ft) |  |  |  |  |  |  |  |  |  |  |  |  | Unknown |  |  | Unknown
 | MEDIA BED DIMENSIONS
 | MEDIA TYPE
 | MEDIA SPECS |  | Material |  | Depth (inches) |  | Min. [NAME] ([NAME]) |  | [NAME]. [NAME] ([NAME]) | UC | Specific Gravity
 | Layer 1 Material |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | UNDERDRAIN TYPE |  |  | SUPPLEMENTAL BW FACILITIES |  |  |  | FILTER LOADING RATE (REG) |  |  | YES/NO LIST
 | Layer 2 Material |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Perforated Pipe |  |  |  |  |  |  | Is it 6.5? |  |  | Yes
 | Layer 3 Material |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Perforated Plate |  |  | Surface Wash |  |  |  | Is it 5? |  |  | No
 | Layer 4 Material |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Wheeler |  |  | Subsurface Wash |  |  |  | Is it 2.5?
 | TOTAL DEPTH  (inches) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Type-S with gravel |  |  | Air Scour |  |  |  | Is it 2?
 | L/D RATIO |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Leopold IMS Cap |  |  | Air Scour (retrofit)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other |  |  | Other
 | UNDERDRAIN TYPE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Unknown
 |  |  | No. of Grades |  | Min. [NAME]   (in) |  | [NAME]. [NAME]   (in) | Total Depth   (in)
 | SUPPORT GRAVEL
 | TROUGHS |  |  |  | SUPPL. BACKWASH |  |  |  |  |  |  |  |  |  |  |  | BW W ATER SOURCE |  |  | CONTROLLER |  |  | METER |  | LOHG
 | Number. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Filter Effluent
 | Separation   (inches) |  |  |  | FILTER-TO-WASTE |  |  |  |  |  |  |  |  |  |  |  | Filters & Pump |  |  | Fix. weir [NAME] |  |  | Proportional |  | Differential Gauge
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Dedicated BW Pump |  |  | Var. weir [NAME] |  |  | Venturi |  | Two Gauges
 |  |  | [NAME] |  | Design |  | Typical | During Backwash |  | Maximum | App'd Exception |  |  |  |  |  | Service Pumps |  |  | Man. Telescoping |  |  | Orifice |  | Water Lvl Indicator
 | FILTER FLOW RATE  (gpm) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Elevated BW Tank |  |  | Man. Butterfly |  |  | Ultrasonic |  | Other
 | LOADING RATE  (gpm/ft2) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Distribution |  |  | Mechanical ROFC |  |  | Propeller
 | BW FLOW RATE  (gpm) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other |  |  | Mot. Valve (Auto.) |  |  | Nunating Disk
 | BW LOADING RATE  (gpm/ft2) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  |  | Paddle
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Orifice Plate |  |  | V-notch weir
 |  |  | Source |  | Controller |  | [NAME] |  | Turbidimeter |  | LOHG |  |  |  |  |  |  |  |  | Head [NAME] |  |  | [NAME]
 | FILTER INFLUENT |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other |  |  | Parshall Flume
 | FILTER EFFLUENT |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other
 | BACKWASH WATER
 | ADDITIONAL REMARKS:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | FLOW [NAME]. |  |  | TURBIDIMETER CAL. |  |  | ROFC CAL. |  | CALIBRATION FREQUENCY |  |  | SOPs
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Unknown |  |  | [NAME] |  |  | Unknown |  | Less than Annual |  |  | Complete
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Weirs |  |  | Stabilzed formazin |  |  | Ultrasonic |  | Annual |  |  | Partial
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Flume |  |  | Polymer beads |  |  | Time & Volume |  | Semi-annual |  |  | Out-of-date
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Ultrasonic |  |  | Gel |  |  | Other |  | Quarterly
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Time & Volume |  |  | Comparison |  |  |  |  | Monthly
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other |  |  | Proprietary device |  |  |  |  | Weekly
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other |  |  |  |  | Daily
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | More than daily
 |  |  |  |  | OPERATING PROCEDURES
 | CALIBRATION |  | [NAME] |  | [NAME] |  | Mech. ROFC |  | NTU (Primary) | NTU (Secondary)
 | Method
 | Frequency
 | Date of Last
 | BACKWASH |  | Turbidity  (NTU) |  | LOH  (ft) |  | Run Time  (hr) |  | Run Volume  (gal) | Filtration Rate
 | Criteria
 | Monitoring Interval
 | WRITTEN SOPs |  |  |  | ADDITIONAL REMARKS:
 | Plant Start-up
 | Filter Start-up
 | Plant Shutdown
 | Filter Shutdown
 | Filter Backwash
 | Filter Inspection
 |  | I certify that I am familiar with the information contained in this report and that, to the best of my knowledge, the information is true, complete, and accurate.
 | Operator's
 | Signature:
 | Operator's Name (printed):
 | Certificate No. and Class: |  |  |  |  |  |  |  | Date:
 | Submit Report to TCEQ/Water Supply Division/Public Drinking Water Section(MC-155), ATTN: Monthly Reports, [NAME], [NAME], TX 78711-3087
 | The report is due the 10th of the following month
 | TCEQ - 10277 (09-01-11) |  |  |  |  |  | PAGE 1 |  |  |  |  | Filter Assessment Report
 | FILTER ASSESSMENT REPORT FOR INDIVIDUAL FILTERS
 | FOR PUBLIC WATER SYSTEMS THAT ARE USING SURFACE WATER SOURCES OR GROUND WATER SOURCES UNDER
 | THE INFLUENCE OF SURFACE WATER THAT ARE REQUIRED TO CONDUCT AN INDIVIDUAL FILTER ASSSESSMENT
 | PUBLIC WATER |  |  |  |  |  |  |  | PLANT NAME
 | SYSTEM NAME: |  |  |  |  |  |  |  | OR NUMBER:
 |  |  |  |  |  |  |  |  | FILTER
 | PWS ID No.: |  |  |  |  |  |  |  | NUMBER:
 |  |  |  |  | CURRENT CONDITIONS
 | DATE |  | TIME |  | TURBIDITY (NTU) |  | [NAME] (ft) |  | FLOW RATE (gpm) | RUN TIME (hr) | RUN VOLUME (gal)
 | PHYSICAL CONDITION |  |  |  | ADDITIONAL REMARKS: |  |  |  |  |  |  |  |  |  |  |  | CONDITION OF FILTER |  |  | CONDITION OF APPERTENANCES |  |  |  | FLOC/MUDBALL DISTRIBUTION
 | Walls |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Excellent |  |  | Fully Operational |  |  |  | Uniform
 | Troughs |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Good |  |  | Slight Malfunction |  |  |  | Localized
 | Suppl. Backwash |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Minor Damage |  |  | Moderate Malfunct |  |  |  | Other
 | Flow Meter |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Moderate Damage |  |  | Severe Malfunction
 | ROFC |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Severe Damage |  |  | Other
 | Flow Control Valve |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other
 | Turbidimeter
 | LOHG
 |  |  |  |  | MEDIA SURFACE CONDITIONS |  |  |  |  |  |  |  |  |  |  |  | TROUGH LEVELNESS |  |  | FLOODING |  | SUPPL. EFFECTIVENESS |  |  | JETTING |  | BBW DISTRIBUTION
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Level |  |  |  |  | Excellent |  |  | Slight |  | Even/Uniform
 |  |  | Before BW |  | After BW |  |  |  | Before BW | After BW |  |  |  |  |  |  | Slighly Unlevel |  |  | Slight |  | Adequate |  |  | Moderate |  | Uneven
 | MOUNDS |  |  |  |  |  | RETRACTION |  |  |  |  |  |  |  |  |  | Moder. Unlevel |  |  | Moderate |  | Poor |  |  | Severe |  | Inadequate
 | Number |  |  |  |  |  | Number |  |  |  |  |  |  |  |  |  | Severely Unlevel |  |  | Severe |  | Ineffective |  |  |  |  | Other
 | Length  (inches) |  |  |  |  |  | Length  (inches) |  |  |  |  |  |  |  |  |  |  |  |  | Complete
 | [NAME]  (inches) |  |  |  |  |  | [NAME]  (inches)
 | Height  (inches) |  |  |  |  |  | Depth  (inches)
 | DEPRESSIONS |  |  |  |  |  | CRACKS
 | Number |  |  |  |  |  | Number
 | Length  (inches) |  |  |  |  |  | Length  (inches)
 | [NAME]  (inches) |  |  |  |  |  | [NAME]  (inches)
 | Depth  (inches) |  |  |  |  |  | Depth  (inches)
 | ACCUMULATED FLOC |  |  |  |  |  | MUDBALLS
 | Thickness  (inches) |  |  |  |  |  | No.  per ft2
 | Distribution |  |  |  |  |  | [NAME]  (inches)
 |  |  |  |  |  |  | Distribution
 | ADDITIONAL REMARKS:
 |  |  |  |  | BACKWASH CONDITIONS
 | BW FLOW RATE   (gpm) |  |  |  | ADDITIONAL REMARKS:
 | RISE RATE  (inches/minute)
 | LOADING RATE  (gpm/ft2)
 | DURATION   (minutes)
 | TOTAL VOLUME   (gallons)
 | TROUGHS
 | Levelness
 | Flooding
 | SUPPL. BACKWASH
 | Duration   (minutes)
 | Effectiveness
 | JETTING
 | No. of Sites
 | Severity
 | BW WATER DISTRIBUTION
 | SPENT BWW TURBIDITY
 | EXPANSION  (inches)
 | EXPANSION  (percent)
 | YIELD   (percent)
 | Submitted by: |  |  |  |  |  |  |  | Date:
 | TCEQ - 10277 (09-01-11) |  |  |  |  |  | PAGE 2 |  |  |  |  | Filter Assessment Report
 | FILTER ASSESSMENT REPORT FOR INDIVIDUAL FILTERS
 | FOR PUBLIC WATER SYSTEMS THAT ARE USING SURFACE WATER SOURCES OR GROUND WATER SOURCES UNDER
 | THE INFLUENCE OF SURFACE WATER THAT ARE REQUIRED TO CONDUCT AN INDIVIDUAL FILTER ASSSESSMENT
 | PUBLIC WATER |  |  |  |  |  |  |  | PLANT NAME
 | SYSTEM NAME: |  |  |  |  |  |  |  | OR NUMBER:
 |  |  |  |  |  |  |  |  | FILTER
 | PWS ID No.: |  |  |  |  |  |  |  | NUMBER:
 |  |  |  |  | FILTER PROBE
 | NUMBER OF SITES |  |  |  | ADDITIONAL REMARKS:
 | MEDIA
 | [NAME]. Thickness   (inches)
 | Min. Thickness   (inches)
 | [NAME]. Thickness   (inches)
 | SUPPORT MATERIAL
 | [NAME]. Elevation
 | Min. Elevation
 | [NAME]. Elevation
 |  |  |  |  | FILTER EXCAVATION
 |  |  | REFERENCE |  | SITE 2 |  | SITE 3 | SITE 4 |  | SITE 5 | SITE 6 |  |  |  |  |  | SITE CONDITION |  |  | MUDBALLS |  | SHARPNESS |  | ENCRUSTATION |  | UNIFORMITY
 | SITE CHARACTERISTIC |  | Normal |  |  |  |  |  |  |  |  |  |  |  |  |  | Normal |  |  |  |  | Excellent |  |  |  | Good
 | LAYER 1   ([NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Media Mound |  |  | Few |  | Good |  | Slight |  | Marginal
 | INTERFACE 1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Media Depression |  |  | Several |  | Worn |  | Moderate |  | Poor
 | LAYER 2 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Crack |  |  | Many |  |  |  | Heavy |  | Other
 | INTERFACE 2 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Retraction
 | LAYER 3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Floc. Accumul.
 | INTERFACE 3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Gravel Mound
 | LAYER 4 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Gravel Depression
 | MUDBALLS |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Poor Suppl. BW
 | [NAME]. [NAME]   (inches) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Jetting
 | Min. [NAME]   (inches) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Poor [NAME].
 | [NAME]. Depth   (inches) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other
 |  |  | SITE 7 |  | SITE 8 |  | SITE 9 | SITE 10 |  | SITE 11 | SITE 12
 | SITE CHARACTERISTIC
 | LAYER 1   ([NAME])
 | INTERFACE 1
 | LAYER 2
 | INTERFACE 2
 | LAYER 3
 | INTERFACE 3
 | LAYER 4
 | MUDBALLS
 | [NAME]. [NAME]   (inches)
 | Min. [NAME]   (inches)
 | [NAME]. Depth   (inches)
 | MEDIA CONDITION |  |  |  | ADDITIONAL REMARKS:
 | Sharpness
 | Encrustation
 | Uniformity
 |  |  |  |  | ADDITIONAL STUDIES
 | FILTER PROFILE ATTACHED? |  |  |  | ADDITIONAL REMARKS:
 | Note: A Filter Profile must be attached to this report.
 | PERCENT MUDBALLS
 | Media Volume  (ml)
 | Mudball Volume  (ml)
 | % Mudballs
 |  |  |  |  | CONCLUSIONS
 | CONCLUSIONS: |  |  |  |  |  |  |  |  | CORRECTIVE ACTION PLAN ATTACHED?
 |  |  |  |  |  |  |  |  |  | WOULD YOU LIKE SOME TECHNICAL ASSISTANCE FROM THE TCEQ?
 | Submitted by: |  |  |  |  |  |  |  | Date:
 | TCEQ - 10277 (09-01-11) |  |  |  |  |  | PAGE 3 |  |  |  |  | Filter Assessment Report
 | FILTER ASSESSMENT REPORT FOR INDIVIDUAL FILTERS
 | FOR PUBLIC WATER SYSTEMS THAT ARE USING SURFACE WATER SOURCES OR GROUND WATER SOURCES UNDER
 | THE INFLUENCE OF SURFACE WATER THAT ARE REQUIRED TO CONDUCT AN INDIVIDUAL FILTER ASSSESSMENT
 | PUBLIC WATER |  |  |  |  |  |  |  | PLANT NAME
 | SYSTEM NAME: |  |  |  |  |  |  |  | OR NUMBER:
 |  |  |  |  |  |  |  |  | FILTER
 | PWS ID No.: |  |  |  |  |  |  |  | NUMBER:
 |  |  |  |  | FILTER SCHEMATIC
 | PREPARE A SIMPLE FILTER SCHEMATIC SHOWING THE LOCATION OF BACKWASH WATER TROUGHS, OBSERVED ANOMOLIES, AND EXCAVATION SITES.
 | Submitted by: |  |  |  |  |  |  |  | Date:
 | TCEQ - 10277 (09-01-11) |  |  |  |  |  | PAGE 4 |  |  |  |  | Filter Assessment Report