Notice:
Beginning with the 2009 lead and copper test period (June through September),
systems are required to report to customers, who provided sampling points, the
results of lead and copper analysis at the customer’s site (home, business, etc.).
This does not apply to sampling that was performed in previous years.
The following forms are provided for reporting these results to customers. The
first two forms are very similar to those provided by the state. The last form is
optional. Some systems that collect a small number of samples have
decided to hand deliver the results to customers. The third form is
provided as a means to show that customers received their results. The
forms may be printed and filled in by hand or completed in Microsoft Word by
right clicking on a field and answering the question when prompted. Directions
are included on the following pages to turn on field shading in Microsoft Word.
All sampling data and a site address list should be forwarded to the Division of
Water Supply Nashville Central Office. This is often handled by the laboratory,
but the water system is responsible for its submittal.
If you have questions concerning lead and copper sampling, you can contact
TAUD field staff, the state Environmental Field Office in your area or Leesa Head
at the Division of Water Supply Nashville Central Office (615-532-0182).
How to use this Guide
Word 97 - 2003 Computer Instructions
On your computer you will need to turn on the shaded field option by following these
steps:
1. Click on “Tools” from the menu.
2. Click on “Options”.
3. Under the “View” tab make sure that field shading says “Always” instead of the
default setting of “When selected” by clicking on the arrow and choosing
“Always” (See Picture Below).
4. When updating the forms just “Right Click” on the shaded fields and left click on
“Update Field” and answer the question if prompted to do so. Some fields are
linked and will update automatically when you click “Update Field”.
5. Ensure that all fields are completed and correct prior to printing
How to use this Guide
Word 2007 Computer Instructions
On your computer you will need to turn on the shaded field option by following these
steps:
1. Click on the “Office Button” in the top left corner.
2. Click on “Word Options”.
3. Click on “Advanced” on the left side of the window.
4. Scroll down to the “Show document content” section.
5. “Field shading” should show “Always”. If not, click the arrow and choose this
option.
6. When updating the forms just “Right Click” on the shaded fields and left click on
“Update Field” and answer the question if prompted to do so. Some fields are
linked and will update automatically when you click “Update Field”.
7. Ensure that all fields are completed and correct prior to printing
Step 1
Step 2
Step 3
Step 4
___________________________________
Lead and Copper Testing Results
Thank you for participating with ___________________________________ in
the monitoring of tap water. Your test results at the tap are: lead __________
mg/L (ppm), and copper __________ mg/L (ppm). The MCLG, or maximum
contaminant level goal for lead is zero mg/L. It is the level of a contaminant in
drinking water below which there is no known or expected risk to health. MCLGs
allow for a margin of safety. The action level for lead is 0.015 mg/L. It is the
concentration of a contaminant which, if exceeded, triggers treatment or other
requirements which a water system must follow. Lead can cause serious health
problems if too much enters your body from drinking water or other sources. It
can cause damage to the brain and kidneys, and can interfere with the
production of red blood cells that carry oxygen to all parts of your body. The
greatest risk of lead exposure is to infants, young children, and pregnant women.
Scientists have linked the effects of lead on the brain with lowered IQ in children.
Adults with kidney problems and high blood pressure can be affected by low
levels of lead more than healthy adults. Lead is stored in the bones, and it can
be released later in life. During pregnancy, the child receives lead from the
mother’s bones, which may affect brain development. The consumer can reduce
their exposure to lead in drinking water by the following:
(I) Run the cold water 15 to 30 seconds to flush out the water in the faucet
body and home plumbing. This is the source of lead in almost all
drinking water from a home tap.
(II) Drink and cook with cold water only, especially do not use hot water for
preparing baby formula.
(III) Please note that boiling water does not reduce lead levels.
The action level for copper is 1.3 mg/l.
For more information call the water utility at ____________________.
___________________________________ TN0000______
Definitions



Below Detection Level (BDL) - laboratory analysis indicates that the
contaminant is not present at a level that can be detected.
Non-Detects (ND) - laboratory analysis indicates that the contaminant is not
present.
Parts per million (ppm) or Milligrams per liter (mg/l) – explained as a relation
to time and money as one part per million corresponds to one minute in two
years or a single penny in $10,000.
___________________________________
Lead and Copper Testing Results
Certification that the notification has been distributed
for
___________________________________
TN0000______
Signature: _______________________________________________
Date: _______________________
Each system must send to the State by October 30 by mail, fax or email:
1) A sample copy of the consumer notification of tap results
2) Certification that the notification has been distributed in a manner consistent with the
requirements of subparagraph (6)(e) of this rule. See 1200-05-01-.33(11)(f)3.
Mail to:
Leesa Head
Division of Water Supply
6th Floor, 401 Church Street
Nashville, Tennessee 37243-1549
FAX: (615) 532-0503
Email: leesa.head@tn.gov
___________________________________
Lead and Copper Testing Results
Customer verification of receipt of Lead and Copper Sampling results.
Site
ID
Address
Customer Signature
verifying receipt of results
Date
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