ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASAT
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For detailed instructions CLICK HERE!
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PWS Name: Fairbanks Elementary School
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PWS ID:OH8039912
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Purpose of this worksheet: To provide a customizable format water systems can use to track materials for each service line in their distribution system.

General Instructions: Each row in this worksheet represents one service line connecting the water main to the customer's plumbing. The worksheet includes required and recommended elements; the columns with the RED shading are required by the LCRR and/or Ohio EPA. The BLUE columns are recommended. Informational notes for columns are in Row 12; Worksheet examples are included in rows 14 &15. This template is formatted for approximately 10,000 rows. The +/- button in the lefthand margin can be used to hide and unhide the PWS Information Box.
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Location InformationSystem-Owned PortionCustomer-Owned PortionOther Potential Sources of LeadAdditional Information to Assign Tap Monitoring TieringLead Service Line Replacement (LSLR)Comments
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Unique Service Line IDSite NameStreet NumberStreet NameCityZip CodeCountyLatitudeLongitudeIn Asset ManagementAsset StatusAsset Start DateAsset End DateSystem-Owned Portion
Service Line Material Classification 		If Non-Lead in Column O…Is the Service Line MeteredService Line UseService Line SizeService Line LengthBasis of Material ClassificationWas the Service Line Material Field Verified?If Yes in Column W…Customer-Owned Portion
Service Line Material Classification		Service Line Installation DateService Line SizeService Line LengthBasis of Material ClassificationWas the Service Line Material Field Verified?If Yes in Column AE…Is there a Lead Connector?Is there Lead Solder in the Service Line?Building Type Connected to Service LineIf Column AJ includes a school...Building Construction DateBuilding Plumbing MaterialsPlumbing installation/replacement date Point-of-Entry or Point-of-Use Treatment Present?LCR Sampling Point IDDate of System-owned LSLRDate of Customer-owned LSLR
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 Was Material Ever Previously Lead?Service Line Installation DateDescribe the Field Verification MethodEnter the Date of Field VerificationDescribe the Field Verification MethodEnter the Date of Field VerificationLowest Grade Served
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A Unique ID by the public water system for each service line.Water systems must track addresses of all service lines in their internal inventory. For the publicly accessible version, location identifiers are required for lead and galvanized requiring replacement. If the system does not use addresses for their location identifier, other options could include GPS coordinates, landmark, intersection, block, or other details to specify service line locations.If "Non-Lead Other", describe in Comments fieldImportant for determining if service line requires replacementEstimated date when the service line was installed or replacedService Line Metered or Not MetteredDrinking, Non-Drinking, CombinationDiameter in inchesLength in FeetSelect option from drop down list. If "Other," describe in the Notes fieldIf Other, describe in the Notes fieldEstimated date of field verification or date that the record was updatedIf "Non-Lead Other", describe in Comments fieldEstimated date when the service line was installed or replacedDiameter in inchesLength in FeetIf Other, describe in the Notes fieldIf Other, describe in the Notes fieldEstimated date of field verification or date that the record was updatedFor example, lead gooseneck or pigtail where the water main is connected to the service lineThis information may be helpful for identifying lead tap monitoring locations.Please use this section to record any comments or notes associated with a service line.
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Example 1Site Name1234Test St.Test City88888Test County##.#####-##.#####Yes, No, UnknownActive, Inactive, Not Applicablemm/dd/yyyymm/dd/yyyyNon-Lead - CopperYes3/19/1999YesDrinking1.506Field inspection only with no recordsNoLead7/4/19051.256Previous materials evaluationYesVisual inspection at the meter pit5/1/2019NoNoSingle Family Structure6/1/1968Galvanized6/1/1968YesLC201
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1House 11502Main StBraceville44444Adams41.2566-80.9806NoActive1/1/20221/1/2023Non-Lead - PlasticNo4/2/2005YesDrinking1.256Previous Materials EvaluationYesVisual inspection at the meter pit5/2/2019Non-Lead - Copper7/12/199129Water sampling only with no recordsNoNoNo Single Family Structure with Childcare Facility2/16/2019Copper with Lead SolderYes
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2Business 11268Main StBraceville44444Adams41.2560-80.9820YesInactive1/15/2016Non-Lead - CopperNoYesCombination2.508Installation record (e.g., tap card)NoNon-Lead - Plastic10/1/20012.0012Installation record (e.g., tap card)YesCustomer self-identification7/2/2017NoNo Non-Residential Building10/1/2001Non-Lead- Plastic7/15/2015No
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Well 1 NorthElementary11140S.R. 38Milford Center43045Union40.1606-83.3907Active1/22/2008Non-Lead - Plastic1/22/2008NoDrinking1.25260Previous materials evaluationNon-Lead - Plastic1/22/20081.25260Previous materials evaluationNon-Residential Building with SchoolK1/22/2008Copper with Lead Solder1/22/2008LC201, LC202, LC203, LC204, and LC205System owns entire service line, Non-transient, Non-Community
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Well 2 SouthElementary11140S.R. 38Milford Center43045Union40.1606-83.3907Active1/22/2008Non-Lead - Plastic1/22/2008NoDrinking1.25250Previous materials evaluationNon-Lead - Plastic1/22/20081.25250Previous materials evaluationNon-Residential Building with SchoolK1/22/2008Copper with Lead Solder1/22/2008LC201, LC202, LC203, LC204, and LC205System owns entire service line, Non-transient, Non-Community
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