checklistfor drinking water source assessment（checklistfor饮用水源评估）（27页）.docVIP

Checklist for Drinking Water Source Assessment Ground Water Source Public water system: ID No.: Name of source: ID No.: Assessment date: Assessment conducted by Water System Contact Name: Phone #: Water System Contact Address: The following information should be contained in the drinking water source assessment submittal. Delineation of groundwater protection zones Source Data Sheet (select appropriate form) Well Data Sheet Spring Data Sheet Horizontal Well Data Sheet Possible Contaminating Activities (PCA) inv