Asbestos

Name	Format	Number
Asbestos Form #1 - Monitoring and Waiver Determination Form	Pdf	N/A
Attachment A (to Form #1) - List of Municipalites Associated with Asbestos-Susceptible Geologic Formations	Pdf	N/A
Asbestos Form #2 - ACP / Aggressive Index Determination Form	Pdf	N/A

Capacity Development

Name	Format	Number
Financial Declaration Form for New Non-Transient Non-Community Public Water Systems	Pdf	n/a
Two-Part Pump Test Form for New Non-Transient Non-Community Public Water Systems	Pdf	n/a
Technical Manual for Determining Reliable Yield for Nontransient Noncommunity Public Water Systems	Pdf	n/a
Technical, Managerial, & Financial Capacity of New Public Community Water Systems	Pdf	BSDW-PA 18
Technical, Managerial, & Financial Capacity of New Public Non-Community Water Systems	Pdf	BSDW-PA 19

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Child Care Center Drinking Water Certification

Name	Format	Number
Checklist for Completing the Child Care Center Safe Drinking Water Requirements	pdf	n/a

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Consumer Confidence Report

Name	Format	Number
2012 CCR Certification Form	Pdf	N/A

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Ground Water Rule

Name	Format	Number
Drinking Water Analysis - Ground Water Rule Source Water Samples Summary Report Form	Pdf	BSDW 99
Drinking Water Analysis - Ground Water Rule Assessment Monitoring Report Form	Pdf	BSDW 100
Ground Water Rule Disinfectant Residual Compliance Monitoring Reporting Form	Excel	BSDW 101

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Inspections

Name	Format	Number
Noncommunity System Inspections	Word	N/A
Deactivation Certification for Non-Community Public Water Systems	Word	N/A

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N.J. Well Vulnerability Questionnaire (SOC)

Name	Format	Number
Vulnerability Questionnaire	Pdf	N/A
Vulnerability Questionnaire Attachments	Pdf	N/A

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Operator Certification

Name	Format	Number
Licensed Operator Internship Program APPLICATION DEADLINE IS JULY 29, 2011	Pdf	N/A
Examination Application for License to Operate	Pdf	ADM-035
Statement of Qualifications	Pdf	ADM 035A
Examination Application for License to Operate a Very Small Water System	Pdf	ADM-368A
Statement of Qualifications	Pdf	ADM-368B
Licensed Operator in Charge of Employment Notification	Pdf	DEP-065

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Physical Connection

Name	Revised	Format	Number
Cancellation of Physical Connection Permit or Elimination of Valves from Permit	Nov-11	Pdf	BWSE-PCR
Application Form for Initial Physical Connection Permit	Nov-11	Pdf	BWSE-PCI-145
Initial Physical Connection Test & Maintenance Report	Nov-11	Pdf	IPCTAF
Physical Connection Permit - Construction Completion Certificate	Nov-11	Pdf	PC-CCC
Quarterly Physical Connection Test & Maintenance Report	Nov-11	Pdf	QPCTMR

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State Revolving Fund

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Water Allocation Applications

Name	Format	Number
Water Allocation Permit Application for New or Major Modifications	Pdf	BWA-001A
Water Allocation Permit Application for Renewals	Pdf	BWA-001B
Water Allocation Permit Application Checklist for Administrative Completeness	Pdf	Checklist
Temporary Dewatering Application	Pdf	BWA-002
Short Term Water Use Permit-By-Rule	Pdf	BWA-003
Short Term Water Use Report	Pdf	BWA-004
Dewatering Permit-By-Rule	Pdf	BWA-005
Contract Approval Application	Pdf	BWA-006
Site Location and Property Information Form	Pdf	BWA-009
C.E.R.C.L.A. Permit Equivalency Application	Pdf	BWA-010
Agricultural Water Usage Certification Application	Pdf	AGC-001
Agricultural Water Use Registration	Pdf	AGR-002
Water Use Registration Application	Pdf	DWR-188
Highlands Water Allocation Application - New or Major Modifications	Pdf	BWA-001HL
Highlands Water Use Registration Application	Pdf	DWR-188HL

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Water Conservation Plan and (Non-Gubernatorial Declaration) Drought or Water Supply Emergency Management Plan

Name	Format	Number
Golf Courses/Irrigation	Pdf	WCP-Golf
Large Volume Users	Pdf	WCP-Large
Public Water Supply Systems	Pdf	WCP-WS

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Water System Compliance

Name	Format	Number
Drinking Water Analysis - Volatile Organics	Pdf	BSDW - 02A
Pesticides, Herbicides, & Other Organics	Pdf	BSDW-04
Drinking Water Analysis - Secondary	Pdf	BSDW-05
Instructions for Drinking Water Analysis-Secondary	Pdf	BSDW-05N
Drinking Water Analysis - Inorganic	Pdf	BSDW-05
Iron & Manganese Input Form	Pdf	BSDW-06
Lead Analysis Input Form	Pdf	BSDW-12
Copper Analysis Input Form	Pdf	BSDW-12
QC Data for Hazardous Contaminant Analysis	Pdf	BSDW-15
Disinfection Byproduct Precursor Compliance Report	Excel	BSDW-20
Instructions for Step One TOC Removal Requirements	Pdf	BSDW-20N
Disinfection Byproduct Precursor Compliance Report Continuation Sheet	Excel	BSDW-21
IESWTR Turbidity Report	Excel	BSDW-22
Instructions for IESWTR Turbidity Report	Pdf	BSDW-22N
Individual Filter Exception Report	Excel	BSDW-23
Individual Filter Assessment Report	Pdf	BSDW-24
Disinfectant Residuals Reporting Form	Excel	BSDW-25
Instruction for Disinfectant Residuals Reporting Form	Pdf	BSDW-25N
Chlorite & Chlorine Dioxide Report	Excel	BSDW-26
Instructions for Chlorite & Chlorine Dioxide Report	Pdf	BSDW-26N
Quarterly Total Trihalomethane (THM4) Report	Excel	BSDW-27
Instructions for Quarterly Total Trihalomethane (THM4) Report	Pdf	BSDW-27N
Quarterly Haloacetic Acid Five Report	Excel	BSDW-28
Instructions for Quarterly Haloacetic Acid Five Report	Pdf	BSDW-28N
Monthly Operators Report for Ground Water Systems	Excel	BSDW-40
Monthly Operating Report for Surface Water Treatment Plant/GWUDISW	Excel	BSDW-41
Drinking Water Analysis - Monthly Coliform Summary Report Form - Coliform form for water systems normally reporting 6 or more per month	Word	BSDW-50
Instructions for Monthly Coliform Summary Report Form	Pdf	BSDW-50N
Drinking Water Analysis - Coliform Samples Report Form - Coliform form for all water systems	Word	BSDW-51
Instructions for Coliform Samples Report Form	Pdf	BSDW-51N
Nitrate/Nitrite Analysis Input Form	Word	BSDW-52
Instructions & Examples for the Nitrate/Nitrite Report Form	Pdf	BSDW-52N
Public Notification Certification Form - Tiers 1, 2 & 3	Pdf	BSDW 53
Certification Form - Consumer Notice of Lead Tap Water Monitoring Results	Pdf	BSDW 54
Public Education Certification Form - Lead Action Level Exceedance	Pdf	BSDW 55
Lead and Copper Sample Site Change Form	Pdf	BSDW 56
Drinking Water Analysis - Ground Water Rule Source Water Samples Summary Report Form	Pdf	BSDW 99
Drinking Water Analysis - Ground Water Rule Assessment Monitoring Report Form	Pdf	BSDW 100
Ground Water Rule Disinfectant Residual Compliance Monitoring Reporting Form	Excel	BSDW 101
Radionuclide Report Form	Pdf	DWR 085
Water Quality Parameters Analysis Input Form (Lead & Copper Rule)	Pdf	WTP 303
DWR BSDW Drinking Water Analysis - Asbestos	Pdf	WSE 014

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Water System Construction Permits

Name	Revised	Format	Number
Construction Completion Certification	Oct-11	Pdf	N/A
Complete Standard Permit Application Form	Oct-11	Pdf	PA-01
Permit Extension of Time Request	Oct-11	Pdf	PA-02
Checklist for Administrative Completeness - Permit Application to Construct/Modify/Operate Public Water Works Facilities	Oct-11	Pdf	PA-05
Firm Capacity & Water Allocation Analysis	Oct-11	Pdf	PA-05E
General Requirements	Oct-11	Pdf	PA-06
Wells - Technical Review Form	Oct-11	Pdf	PA-07
Surface Water Supplies - Technical Review Form	Oct-11	Pdf	PA-08
Surface Water Treatment Rule - Technical Review Form	Oct-11	Pdf	PA-08A
Surface Water Supplies Watershed Monitoring	Oct-11	Pdf	PA-08B
Pump Stations - Technical Review Form	Oct-11	Pdf	PA-09
Distribution Systems - Technical Review Form	Oct-11	Pdf	PA-10
Master Permit for Main Construction	Oct-11	Pdf	PA-10A
Checklist for Determination of Permit Requirements for Water Main Construction	Oct-11	Pdf	PA-10DET
Distribution Storage - Technical Review Form	Oct-11	Pdf	PA-11
Chemical Handling & Feeding - Technical Review Form	Oct-11	Pdf	PA-12
Pretreatment - Technical Review Form	Oct-11	Pdf	PA-13
Filtration -Technical Review Form	Oct-11	Pdf	PA-14
Aeration - Technical Review Form	Oct-11	Pdf	PA-15A
Fluoridation - Technical Review Form	Oct-11	Pdf	PA-15F
Packed Column Aeration - Technical Review Form	Oct-11	Pdf	PA-15G
Granular Activated Carbon Contractors - Technical Review Form	Oct-11	Pdf	PA-15H
Chlorination - Technical Review Form	Oct-11	Pdf	PA-16
Ozone Generation & Feeding - Technical Review Form	Oct-11	Pdf	PA-17

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Ground Water Under the Direct Influence

Name	Format	Number
Checklist for the Determination of Ground Water Status	Pdf	N/A

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Ground Water Rule

Name	Format	Number
Existing 4-log Virus Treatment Under the Ground Water Rule	Pdf	N/A
Representative Source Water Monitoring Plan Summary Sheet	Pdf	N/A
Representative Source Water Monitoring Plan Certification	Pdf	N/A

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Well Permitting

Licensing

Name	Format	Number
Master Well Driller	Pdf	N/A
Journeyman/Journeyman B Well Driller	Pdf	N/A
Monitoring Well Driller	Pdf	N/A
Soil Borer	Pdf	N/A
Dewatering Well Driller	Pdf	N/A
Pump Installer	Pdf	N/A

Well Search

Name	Format	Number
Individual Well Search Questionnaire	Word	N/A
Individual Well Search Procedure	Pdf	N/A
Radius Well Search Procedure	Pdf	N/A
Radius Well Search Form	Pdf	N/A

Well Construction/Decommissioning

Name	Format	Number
Well Abandonment Report Form	Word	N/A
Well Permit Cancellation Form	Pdf	N/A
Blanket 2” Well Decommissioning Approval Form	Pdf	N/A
Blanket 2” Well Decommissioning Cover Letter	Pdf	N/A
Well Construction Deviation Form	Pdf	N/A

Well Drilling Licensing Form

Name	Format	Number
Well Driller License Address Update Form	Pdf	N/A

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