3900-FM-BSDW0483
9/2013
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF SAFE DRINKING WATER
Monthly Calibration Check
UV Intensity Sensors
Reporting Month and Year:
System / Treatment Plant:
PWSID:
Performed By:
Date:
Sensor Calibration Ratio: Duty Sensor Reading / Reference Sensor Reading
(Acceptability: Sensor Calibration Ratio less than or equal to 1.20)
Unit No.
Duty
Sensor
ID
Duty Sensor
Serial No.
Ref
Sensor
ID
Ref Sensor
Serial No.
-1-
Ref
Sensor
Intensity
(W/m2 or
mW/cm2)
Duty
Sensor
Intensity
(W/m2 or
mW/cm2)
Sensor
Calibration
Ratio
Acceptable?
Y
N
3900-FM-BSDW0483
9/2013
UV Intensity Sensors Needing Recalibration
Unit No.
Sensor Serial No.
Date Sent
Company Performing Recalibration
Date
Returned
Recalibration
Successful?
Y
N
Check here if recalibration was not needed during this reporting month.
Completed Form Reviewed By:
Authorized Representative’s Name (printed):
Date:
Authorized Representative’s Signature / Date:
-2-