Drinking Water Forms

The forms on this page are for public water systems and regulations for Chapter 8, public water supply. Some forms, such as the analytical results form, are not available in electronic format. Hard copies of these forms are available on request from the Division of Water. 

To find additional forms on the Division of Water Web site, use the Search feature in the upper right corner of this page by entering the name of the form and pressing "Go."

Drinking Water Forms

Form Title	Year Revised	FORMAT -- DOWNLOAD	Required by Chapter 8
NEW! Asbestos Monitoring Waiver for Purchasers (DOC file) PDF File -- Asbestos Monitoring Waiver for Purchasers	2008	DOC and PDF	No
Distribution System Checklist Form in Word Distribution System and Waterline Submittal Checklist (DEP-7102)   Refer to Drinking Water Plans Review	2006	PDF	No
Sanction Exception Form (for tap-on bans)   Refer to Drinking Water Sanctions	2000	PDF	Yes
Monthly Operating Report, updated Jan. 2008, EXCEL file Instructions for new eMOR form (Word) Letter concerning new eMOR form (Word)		EXCEL Word Word	Yes
Consumer Confidence Report (CCR) Certification form (DEP-6058)	2007	PDF	Yes
CCR Builder available from the Kentucky Rural Water Association (KRWA).	2007	EXCEL	No
Public Notice (PN) Certification form (DEP-6060) EXAMPLE Public Notification (PN)	2008 2005	WORD PDF	Yes Example PN
Optimization assessment spreadsheet (Turb-Opt Version 27)	2004	EXCEL Template	No
Jar Test 29 KY version 1.	1998	EXCEL Template	No
Total Organic Carbon (TOC) Worksheet	1999	EXCEL	No
Compliance Forms for Chemical Analytical Results relating to SDWIS/State (Jan. 2006)
Asbestos Form	2006	Word	Yes
Bacteriological Form	2006	Word	Yes
Bromate Form	2006	Word	Yes
Bromide Form	2006	Word	Yes
Chlorite Form	2006	Word	Yes
Dioxin Form	2006	Word	Yes
Generic Chemical Analysis Reporting Form	2006	Word	Yes
Generic Radionuclides Reporting Form	2006	Word	Yes
Haloacetic Acid Five (HAA5) and Total Trihalomethane (TTHM) Reporting Form	2006	Word	Yes
Instructions For Chemical Forms	2006	Word	Yes
Inorganic Chemicals (IOCs) Reporting Form	2006	Word	Yes
Lead and Copper:  Table 5, Table 10, Table 20, Table 30, Table 40, Table 50, Table 60	2006	EXCEL	Yes
Lead/Copper Rule Results Notification Form	2008	Word	Yes
Lead/Copper Rule Results Delivery Certification Form	2008	Word	Yes
Kentucky Method Codes updated Oct. 13, 2006	2006	EXCEL	Yes
Nitrate Form	2006	Word	Yes
Lead and Copper Reporting Form	2006	Word	Yes
Radionuclides Reporting Form	2006	Word	Yes
Reporting Limits Form updated March 2008	2008	Word	Yes
Secondary Contaminant Reporting Form	2006	Word	Yes
Synthetic Organic Chemicals (SOCs) Reporting Form	2006	Word	Yes
Sodium Form	2006	Word	Yes
Total Organic Carbon (TOC) Form  (Disinfection Byproduct Precursor Analysis Reporting Form)	2006	Word	Yes
Volatile Organic Chemicals (VOCs) Reporting Form	2006	Word	Yes
Water Quality Parameters Reporting Form	2006	Word	Yes
The SDWIS Electronic Submission Upload page.	2006
Please contact Jerry Pike at 502-564-3410 about SDWIS/State and the new chemical analytical forms.

Information about: 

• Consumer Confidence Reports -- EPA tools  
• Groundwater (Dye Trace Notification) forms
• KPDES permit application forms  
• SDWIS/State reporting
• Well Driller Forms
• Implementing the Lead Public Education Provision of the Lead and Copper Rule: A Guide for Community Water Systems
• Implementing the Lead Public Education Provision of the Lead and Copper Rule: A guide for Non-Transient Non-Community Water Systems