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Currency [0]/Explanatory TextG5Explanatory Text % 0Good;Good  a%1 Heading 1G Heading 1 I}%O2 Heading 2G Heading 2 I}%?3 Heading 3G Heading 3 I}%234 Heading 49 Heading 4 I}% 5InputuInput ̙ ??v% 6 Linked CellK Linked Cell }% 7NeutralANeutral  e%"Normal 8Noteb Note   9OutputwOutput  ???%????????? ???:$Percent ;Title1Title I}% <TotalMTotal %OO= Warning Text? Warning Text %XTableStyleMedium2PivotStyleLight16`HSheet1  ;3`ifNf8@bZ  3  @@   PWSID # :Location Town/City: UV Model:Signature of Owner or Operator:DateUSend completed form to the Drinking Water Program by the 10th of the following month.UV Equipment Manufacturer:Replaced Bulb?Date !Reporting Period (Month and Year)Cleaned Lamp Sleeve/Bulb?Changed Sediment Filter?Water System Name:Water Operator Name: Alarm OK?Number of Gallons Pumped& & & .& ..DAILY CHECKS& & & ...& ..." MAINTENANCE, REPAIRS, ADJUSTMENTSDate Sleeve/Bulb Last Cleaned?Date Bulb Last Replaced?%Date Sediment Filter(s) Last Changed?LSmall Water System Monthly Operating Report for Ultra-Violet Treatment (UV) EQUIPMENT CHECK LOG q{Equipment Checks are Required to be Done Twice a Week but the DWP Strongly Encourages That Checks be Done Daily}ZList any problems or special situations that occurred with the treatment during the month.jList other Maintenance, Repairs, or Adjustments done. dMAIL TO: DHHS, fb88 Drinking Water Program, 11 State House Station, Augusta, fb88 04333-0011 ;or E-MAIL: DWPMOR@maine.gov or FAX: 287-4172 (1Are Intensity and/or % Transmittance Readings Within Acceptable Range(s)? 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