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Water System No.: Water System Name: <br />Primary Station Code: Source Name: <br />Step 1: Has Historical Monitoring for Gross Alpha Been Completed? <br />Column 3Column 2Column 1 <br />GA Result2 (pCi/L) <br />^7 <br /> One sample every nine years if the average/composite of the monitoring results is below 3 pCi/L <br />Page 1 of 3 <br />2 <br />3 <br />4 <br />5 <br />Have four consecutive quarters of Gross Alpha monitoring been completed for this source since January 1, 2001? <br />¥es - monitoring completed. Please fill out Table 1 below. <br />CEROne sample every six years if the average/composite of the monitoring results is greater than or equal to 3 <br />pCi/L but less than or equal to 7.5 pCi/L <br />Complete a separate form for each active source serving your water system. <br />Submit to your DWFOB district field office prior to implementing a reduced monitoring frequency. <br />California Department of Health Services <br />Drinking Water Field Operations Branch <br />Community Water Systems - Assessment of Historical Radionuclide Monitoring <br />Purpose of this form: To determine whether radionuclide monitoring frequency may be reduced <br />on the basis of historical data, as allowed under the new Federal and draft State Radionuclide <br />Rules. <br />Multiply <br />0.84 xC£4 <br /> No - The system must complete four consecutive quarters' of Gross Alpha monitoring for this source <br />by December 31, 2007. <br />TABLE 1 - Gross Alpha (GA) Data <br />Column 4 <br />1 For Gross Alpha, Uranium, Radium-226 and Radium-228. and Total Radium, the Department may waive the final two <br />quarters of initial monitoring if the results from the first two quarters are below the DLR(s). <br />For negative values and values less than the DLR (i.e. ND) assign a value of zero (0). <br />CE = Counting Error. <br />0.84 x CE is the 95% one-tailed confidence interval for the counting error (1.65/1.96 = 0.84) <br />Use the average of the four Gross Alpha analysis results in Table 1 Column 2 to determine the reduced monitoring <br />frequency for this source. <br />CE3Date of Sample <br />f-_____ <br />Average/composite <br /> One sample every three years if the average/composite of the monitoring results is greater than 7.5 pCi/L <br />but less than or equal to 15 pCi/L <br /> Quarterly if the average/composite of the monitoring results is greater than 15 pCi/L <br />I <br />Step 2: Determination of Reduced Monitoring Frequency for Gross Alpha' <br />The reduced monitoring frequency is based on the average/composite shown in Table 1, Column 2. <br />Choose the appropriate frequency below. <br />Column 5 <br />(to be used in Steps 3 & 4) <br />GA Result+ (0.84 xCE) <br />(Sum of values in Columns 2 and 4) <br />__________