MONTHLY OPERATING REPORT
                                  FOR GROUNDWATER TREATMENT PLANTS THAT ARE REQUIRED TO PROVIDE 4-LOG VIRAL INACTIVATION
                  WATER SYSTEM NAME:                                                                                           PWS ID No.: 
                  PLANT NAME OR NUMBER:                                                                                               Month:
                  Minimum Specified Residual:                                   mg/L                                                    Year:
                                                                                WATER PRODUCTION
                                    Total Daily         Measured Residual               Hours                Flow Rate                                Temp
                                                                                                                                                        o
                                Production (MGD)               (mg/L)                 (decimal)                (gpm)                 pH                ( C)
                     1
                     2
                     3
                     4
                     5
                     6
                     7
                     8
                     9
                     10
                     11
                     12
                     13
                     14
                     15
                     16
                     17
                     18
                     19
                     20
                     21
                     22
                     23
                     24
                     25
                     26
                     27
                     28
                     29
                     30
                     31
                   Total                                                          For TCEQ Use Only
                    Avg                                                           Potential Violations
                    Max                                                             M&R
                    Min                                                              TT
                Any additional information you wish to provide:
                             I certify that I am familiar with the information contained in this report and that, to the best of my 
                             knowledge, the information is true, complete, and accurate.
                Operator's
                Signature:                                                                         Date:
                Certificate No. and Class:
                  TCEQ - 20362 (09-15-09)                                                                                                                  MSRMOR