Figure: 30 TAC 285.90(3)

Figure 3. Sample Testing and Reporting Record.

This testing and reporting record shall be completed, signed and dated after each maintenance check and test. One copy shall be retained by the maintenance company. The second copy shall be sent to the local permitting authority and the third copy shall be sent to the system owner.

        1.     Required frequency of maintenance check and tests - (daily, weekly, monthly, quarterly, every 4
                months).

                 Actual date of test: ____________________


       2.    System inspection:                 Property Address: ______________________________________
                                                                  Permit Number: ________________________________________
                                                                  Person Performing Inspection: _____________________________
                                                                                                                          _____________________________
                                                                                                                                            (Signature)


            Inspected Item                          Operational                         Inoperative

            Aerators
               Filters
               Irrigation Pumps
               Recirculation Pumps
               Disinfection Device
               Chlorine Supply
               Electrical Circuits
               Distribution System
               Sprayfield Vegetation/Seeding
                                    (if applicable)
               Other as Noted

      3.     Repairs to system (list all components replaced):________________________________________
                _____________________________________________________________________________
               _____________________________________________________________________________

      4.     Tests required and results:

                            Test                         Required                    Results                                                     Test
                                                                    Yes   No                     mg/l, mpn/100 ml, or trace                                        Method


                     BOD (Grab)
                            TSS (Grab)
                            Cl2 (Grab)
                            Fecal Coliform

         5.     Date(s) responded to owner complaints during reporting period (attach copy of complaint and
                 findings): _______________________________________________________________


        6.      General comments or recommendations: ______________________________
            _________________________________________________________________
           ___________________________________________________________________