Dnr Form 542-0465 - Change Of Sampling Site For Disinfection Byproducts
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1Iowa Department of Natural Resources
Change of Sampling Site for Disinfection Byproducts
(TTHM and HAA5)
Note: The replacement site must meet the same targeting criteria as the original site. For example: If the original site was
a location where high levels of TTHM were expected, then the replacement site must also be a high TTHM location. If
only one site was used in the past, chose a replacement site with the highest levels of TTHM.
Typical Characteristics of Selected Sites
High TTHM sites are at the maximum residence time and are often located:
• hydraulically downstream of storage facilities and booster disinfection,
• in hydraulic dead-ends, where flow of water is low or stagnant, or
• near the ends of the distribution system, at or before the last group of customers.
High HAA5 sites are often located:
• in average residence time locations,
• after booster disinfection with chlorine, or
• low but detectable chlorine residual.
Sample sites should not be located:
• at a dead-end where there are no customers,
• before booster disinfection with chlorine,
• after the last hydrant or blow-off point, or
• in areas with significant biofilms or high heterotrophic bacteria plate count.
System Name:
PWSID: IA
Targeting criteria for the original site (circle one):
High TTHM
High HAA5
Reduced High TTHM and High HAA5
Sample Point ID: DB
(Note: The sample point ID from the original site will continue to be used for the new site.)
Original site address:
New site address:
Approximate distance between the two sites:
Reason for changing the site:
Name (print):
Title:
Signature:
Date:
Next step:
1. Keep this form with your current Stage 2 DBPR Sampling Plan.
2. Send a copy of the form to:
Iowa DNR – Water Supply Operations Section
th
502 E 9
St
Des Moines, IA 50319-0034
DNR Form 542-0465
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