Approvals - River Vale Public Schools · public. The Project Manager reports to the Program Manager. 2.2 School District Project Manager (Project Manager) The Project Manager is responsible

Quality Assurance Project Plan (QAPP)

For

Drinking Water Sampling

of Lead Concentrations in School Drinking Water

Outlets

River Vale School District

Approvals

:r:na:llItO

Pnt Name S DateKenneth Peterson

Project Manager(s):

_____________________ ___________________________

4./J’) / J7Pñnt Name Signature “Date

IndMdual School Project Officer(s) (See page iii)

Third Party Sampling Firm: Lew Corporation(Note N/A if Third Party not involved) Name of Firm

Phrrt Name Signature Date

Laboratory:

______________________________________________

Name of Laboratory

Laboratory Manager:Print Name Signature Date

Laboratory QA Officer:

___________________ ______________________________

Print Name Signature Date

For additional laboratories conducting sampling and or analysis use additional sheet forsign-off.

Version 1.1 July 21, 2016 (NJDEP)

Laboratory:Name of Laboratory

Laboratory Manager:Print Name S4gnature Date


____________________ __________________________

—


Laboratory Manager:Print Name Signatura Date


____________________ __________________________


Laboratory Manager:Print Name Snature Date


___________________ _________________________

Laboratory:

__________________________________________

Name of Laboratory

Laboratory Manager:Print Name Signature Date


Version 11July21, 2016 (NJDEP)

Individual School Project Officers (ISPO)

School Name

Hoidrum Middle Terrance McCannSchool Phone: (201) 358-4000

ext._1040Roberge Annex John Menniti

Phone: (201) 358-4000Ext. 3040

Roberge Elementary John MennitiSchool Phone: (201) 358-4000

Ext. 3040Woodside Elementary Alan MakelaSchool Phone: (201) 358-4000

Ext._2040

Phone:

Phone:

Phone:

Phone:

Phone:

Phone:

Phone:

Phone:

Phone:

Phone:

Phone:

Phone:

Phone:

j Phone:

Add additona sheets as necessary.

III

Head Custodian


Table of Contents1. Objective & Goals/Background.7

1.1 Objective and Goals 7

1.2 Background 7

2. Project/Task Organization 8

2.1 School District Program Manager (Program Manager) 8

2.2 School District Project Manager (Project Manager) 8

2.3 Individual School Project Officer(s) 9

2.4 Laboratory Manager 10

2.5 Laboratory’s Quality Assurance Officer (LQAO) 11

2.6 Field Sampler or Field Sampling Team 11

3. Special Training Needs/Certification 11

4. Project/Task Description 11

5. Lead Data Quality Objectives and Criteria for Measurement 12

5.1 Precision 12

5.2 Bias 12

5.3 Representativeness 12

5.4 Comparability 13

5.5 Completeness 13

5.6 Sensitivity 13

6. Secondary Data 13

7. Field Monitoring Requirements 13

7.1 Monitoring Process Design 14

7.2 Monitoring Methods 14

7.3 Field Quality Control 14

8. Analytical Requirements 15

8.1 Analytical Methods 15

8.2 Analytical Quality Control 15

9. Sample Handling and Custody Requirements 16

9.1 Sample Archive/Disposal 16

10. Instrument/Equipment Testing, Inspection, Maintenance & Calibration Requirements 16

10.1 Instrument/Equipment Testing, Inspection and Maintenance 16

1

10.2 Instrument/Equipment Calibration and Frequency 17

10.3 Inspection/Acceptance of Supplies and Consumables 17

11. Data Management 17

12. Assessments/Oversight 18

13. Data Review, Verification, Validation, and Usability 18

13.1 Data Review, Verification and Validation 18

13.2 Reconciliation with User Requirements 18

14. Reporting, Documents and Records 19

Appendix A:3Ts for Reducing Lead in Drinking Water in Schools 20

Appendix 8: Insert School District Lead Water Testing Sampling Plan 21

Appendix C:_Chain of Custody 2

Appendix D:_Excel Template for Lead Results 23

2

1. Objective & Goals/Background

1.1 Objective and Goals

A Quality Assurance Project Plan is a document that describes the planning,implementation and evaluation steps involved in the acquisition of data that will beused to arrive at a specific goal. The overall objective for this QAPP is to determine thelead concentration at drinking water outlets within the District’s schools so thatcorrective action(s) may be implemented at any drinking water outlets sampled found toexceed the US Environmental Protection Agency (USEPA) drinking water lead actionlevel of 1 5 micrograms per liter (ig/L).

For the purposes of compliance, any concentration greater than 15 pg/L(as defined as greater than or equal to 15.5 pg/L) is considered to

exceed the lead action level.

The lead sampling will consist of the collection of a first draw (initial) sample accordingto this QAPP and the School District Lead Water Testing Sampling Plan (SamplingPlan). The drinking water outlets can be faucets, drinking water fountains (or bubblers)and water coolers (see Sampling Plan for details).

Follow-up sampling will also be covered by this QAPP and the Sampling Plan. Anoptional follow-up flushed sample may be analyzed at selected drinking water outletsafter flushing for 30 seconds. (An exception to the 30 second follow-up flushed sampleis for a water cooler which requires a different follow-up sampling timeframe).

The analytical results and field data will be used by the Project Manager and the District(See Section 2.2) to determine whether drinking water distributed from drinking wateroutlets such as water fountains (bubblers), faucets, food preparation areas and watercoolers have concentrations of lead that exceed 15 j.igIL. If a first draw (initial) or follow-up flushed cold water sample is found to contain lead at a concentration greater than 15pg/L, the Project Manager will instruct the Individual School Project Officer (ProjectOfficer) (See Section 2.3) to isolate the source of drinking water by turning off the deviceor providing a barrier to the consumption of the water (tape and bag) until appropriateremediation is determined.

1.2 Background

Lead is a toxic metal that can be harmful to human health when ingested. Youngchildren are particularly sensitive to the effects of lead because their bodies are stillundergoing development. Lead can get into drinking water by being present in thesource water or by interaction of the water with plumbing materials containing lead

Page 7 of 23Ver&on 1.1 July 21, 2016 (NJDEP)

(through corrosion). Common sources of lead in drinking water include: solder, fluxes,pipes and pipe fittings, fixtures, and sediments. It is possible that different drinking wateroutlets in a given building could have dissimilar concentrations of lead.

In April 1994, USEPA prepared two guidance documents to assist municipalities inmeeting the requirements of the Lead Contamination and Control Act (LCCA): Lead inDrinking Water in Schools and Non-Residential Buildings (EPA 81 2-B-94-002) andSampling for Lead in Drinking Water in Nursery Schools and Day Care Facilities (EPA812-B-94-003). In December 2005, amended October 2006, EPA issued the revisedtechnical guidance document 3Ts for Reducing Lead in Drinking Water in Schools (EPA816-B-05-008) which replaced the Lead in Drinking Water/n Schools and NonResidential Buildings (EPA 81 2-B-94-002). The 3Ts Revised Technical Guidancedocument is meant to assist school officials in implementing programs and policies toreduce children’s exposure to lead in drinking water in schools.

2. Project/Task Organization

2.1 School District Program Manager (Program Manager)

The School District Program Manager is the overall authority in the execution of theDistrict’s lead sampling project. He/she is responsible for the initial notification to theDistrict of the testing program, obtaining funds for testing, assigning the ProjectManager, requesting/enlisting the assistance from other District departments if needed,approving the District’s QAPP(s), approving the Final Report for each school andcoordinating with other District officials to make the results of the testing available to thepublic. The Project Manager reports to the Program Manager.

2.2 School District Project Manager (Project Manager)

The Project Manager is responsible for overseeing the execution of lead sampling ateach of the district’s schools. This involves the prioritization of schools to be sampled,and adherence with the District’s Sampling Plan and QAPP. He/she serves as theliaison between the School District, State agencies, local Health Departments,laboratories and public water systems (if applicable). He/she reports to the ProgramManager.

The Project Manager’s responsibilities include:• Preparing the District’s Specific QAPP• Managing the Sampling Plan and QAPP.

Page 8 of 23Version 1.1 July 21, 2016 (NJDEP)

• Oversight of Individual School Project Officers (Project Officers) to ensure thatthey adhere to the Sampling Plan procedures and the QAPP.

• Purchasing of equipment needed for district lead sampling• Coordination with New Jersey laboratories certified for lead in drinking water• Coordination with Project Officers to establish sampling schedules• Ensuring properly signed QAPPs are in place prior to initiation of sampling• Verify that officials from each school are aware when sampling is scheduled and

the expected duration• Review of the School Field Sampling Summary Reports prepared by Project

Officers• Review of Laboratory Data Reports (LDR) from Laboratory Managers• Review of Final Project Reports prepared by Project Officers. Identify limitations

in the use of any laboratory data due to information provided in theaccompanying School Field Sampling Summary Report.

• Maintain the original signed QAPP(s)• Maintain documents, reports and records listed in Section 14 of the QAPP

o Laboratory Data Reports (LDR)o Copy of Field Sampling Summary Report with copies of field logbooks,

field Walk-Through reports including Attachments B, C, D, E, and F of theLead Sampling Plan, chains of custody and flush tags.

o Copy of Final Project Report• Maintenance of other relevant records such as:

o Purchase orders for analytical costs (copy).o Agreement with laboratory to sample/analyze/report with details for

paymento Receipts (originals or copies)

2.3 Individual School Project Officer(s)

The Individual School Project Officer’s responsibilities include:

• General project oversight for assigned school(s).• Generate field log book for each assigned school. Document field activities

including any changes to procedures outlined in the Sampling Plan or QAPP.• Ensure proper completion of the Plumbing Profile for assigned school(s) - See

Attachment B of the Sampling Plan.• Oversight of completion of the following reports found in the Sampling Plan which

require sign—off by Project Officer:o Drinking Water Outlet Inventory (Sampling Plan Attachment C)o Filter Inventory Report (Sampling Plan Attachment D)o Flushing Log (Sampling Plan Attachment E)

Page 9 of 23Version 1.1 July21, 2016 (NJDEP)

o Pre Sampling Water Use Certification (Sampling Plan Attachment F).• Prepare labels for drinking water outlets to be sampled.• Prepare for Walk-Thru including acquisition of School Floor Plan.• Attend school Walk-Thru.• Ensure proper completion of Walk-Thru documentation including identification of

drinking water outlets on Floor Plan, and Sampling Location Inventory with codingaccording to the Sampling Plan (Attachment C of Sampling Plan).

• Supervision of field activities such as Walk- Thru, flushing (if required), lockingschool prior to sampling, and sample collection.

• Identify drinking water outlets to be flushed and attach flush tag.• Ensure that Field Sampling Team has all relevant sampling supplies including

sampling bottles, labels, proper reagent water and chains of custody prior tocollection of samples.

• Ensure that all drinking water outlets to be sampled prior to sampling event arelabeled.

• Ensure that any low-use drinking water outlets identified for sampling had beenflushed.

• Remove flush tags from drinking water outlet once sampling is completed.• Responsible for ensuring water remains motionless for a minimum of eight hours

(last to leave the school) prior to sampling event by following procedures inSection 8 of Sampling Plan.

• Verify that the Sampling Plan was followed prior to initiating sampling bycompleting the Pre-Sampling Water Use Certification (Attachment F in SamplingPlan).

• Supervision of sampling event.• Documentation of issues during sampling event in field log book.• Preparation of Field Walk-Thru Report, School Field Sampling Summary Report

and Final Project Report for assigned school(s).• Maintenance of field log books for each school.• Prepare samples for shipment and delivery to laboratory per certified laboratory

instructions.• Ensure that samples are delivered to laboratory within the time period specified

by the certified laboratory

2.4 Laboratory Manager

The Laboratory Manager is responsible for:

• Supervising laboratory analyses to be performed in the Laboratory. Thisincludes oversight of all QA requirements in the laboratory, data review, andqualification of the data.

• Providing the Laboratory Data Report Package to the Project Manager andProject Officer.


2.5 Laboratory’s Quality Assurance Officer (LQAO)

The Laboratory’s Quality Assurance Officer (LQAO) is responsible for reviewing theQAPP and resolving any QA issues that may arise during the project.

2.6 Field Sampler or Field Sampling Team

The Field Sampler or Field Sampling Team, whether affiliated with the District, NJcertified laboratory, and/or Environmental Consulting Firm, is responsible for ensuringthat field activities are conducted in accordance with this QAPP and the Sampling Plan.

3. Special Training Needs/Certification

Sampling will be performed by the District, a certified Laboratory, or an EnvironmentalConsulting Firm-designated Sampling Team staff. Staff performing the samplecollection will be properly trained in sampling techniques.

Laboratory personnel designated to analyze the samples will have successfullycompleted required demonstrations of capability for the methods used. The Laboratorymust be a drinking water laboratory certified by New Jersey for the analysis and reportingof lead using USEPA drinking water methods which are listed in Section 8.

Assessments of the Laboratory capability are conducted on a bi-annual basis by theNJDEP Office of Quality Assurance. The Laboratory Manager has responsibility forcorrection of all deficiencies in their laboratory program.

4. Project/Task Description

Drinking water samples will be collected from drinking water outlets including waterfountains (bubblers), food preparation outlets (located in the cafeteria, kitchen, andhome economics classrooms) and other outlets where there is the possibility of drinkingthe water such as in the special education classrooms, the medical office, the teachers’lounge, and ice machines. Concession stands and outside water fountains (such as inplaygrounds and athletic fields) may also be considered for sampling. The custodiansink faucet may also be considered for sampling if it is used for filling large watercoolers to provide water at school events. Outside hose spigots are not appropriatesampling locations for the purpose of this QAPP. The Sampling Plan provides moredetail on appropriate sampling locations.

The Field Sampler or Team will conduct first draw (initial) sample collection and, asappropriate, follow-up flushed sample collection at the drinking water outlets specified inthe Sampling Plan. The Sampling Team will consist of the Project Officer and theSampler who will be affiliated with either the District, Laboratory, or the Environmental


Consulting Firm. The NJ Certified Laboratory specified in the QAPP will perlorm theanalysis for lead.

5. Lead Data Quality Objectives and Criteria for Measurement

5.1 Precision

The NJ Certified Laboratory will perform replicate analysis of the Laboratory ControlStandard (LCS) for every set of individual school samples to assess method precision.This is not a requirement of any of the USEPA approved methods for lead analysis.The acceptance criterion for replicate analysis is a maximum of 20 percent (%) RelativePercent Difference (RPD). In addition to the LCS data, a duplicate laboratory fortifiedblank (LFB) or a matrix spike and a matrix spike duplicate (MS/MSD) will also provideprecision information.

5.2 Bias

As part of the analytical methodology, the NJ Certified Laboratory will perform analysisof laboratory fortified blanks (LFB) to assess accuracy/bias. The acceptance criterionfor accuracy is for the results to be within plus or minus 1 5% recovery of the knownvalue.

A field reagent blank (FR B) must be collected for each school. The FRB is normally onlya requirement for USEPA Method 200.8, however the collection of a FRB is required withany of the other approved lead methods for this sampling event. The informationprovided by the results is used to determine whether the field or sample transportingprocedures and environmental effects have contributed to contamination of the sample.

If any sample result(s) are qualified, this must be clearly indicated on the report and allfinal reports such as the field summary report. The Project Manager must be consulted todetermine how to deal with the qualified results.

5.3 Representativeness

The sampling effort is designed to identify all drinking water outlets, within a school,where there is a potential for water consumption such as at water fountains (bubblers)that may require corrective action due to first draw and/or follow-up flushed sampleresults that exceed 1 5 ig/L of lead (as defined as greater than or equal to 15.5 ig/L orgreater). Food preparation outlets and other potential ingestion outlets such as specialeducation classrooms, the medical office and bathroom sinks are to be considered forsampling.


5.4 Comparability

The analytical methods for lead analysis in drinking water are found in the federal SafeDrinking Water Regulations at 40 CFR141 .86 and 40 CFR 141 Appendix A to SubpartC. Use of these methods allows for the comparison of data to USEPA’s drinking wateraction level for lead of greater than 15 ig/L.

Analytical results from the first draw (initial) and the follow-up flushed samples will becompared to assist in determining the source of lead contamination. Appropriatecorrective measures must then be taken by the District.

For those school facilities with their own source (classified as a nontransientnoncommunity water system), the results should be submitted to the NJDEP and usedto assess compliance with the action levels in EPA’s Lead and Copper Rule.

5.5 Completeness

In order to satisfy the objective of the project, samples will be collected from drinkingwater outlets according to the sampling plan established in this QAPP.

One hundred percent (1 00%) of collected and verified samples will be analyzed andreported.

5.6 Sensitivity

The Laboratory’s Reporting Limit (RL) for the determination of lead in drinking watersamples must be no higher than 2 iig/L which is lower than the regulatory PracticalQuantitation Level for lead of 5 ig/L. The Practical Quantitation Level for Lead is statedin the National Primary Drinking Water Contaminant Regulations 40 CFR141 Subpart I.The required reporting limit of 2 jg/L for this QAPP is achievable with any of theapproved USEPA methods listed in 11.1.

6. Secondary Data

Secondary data for the District would be their historical lead data.

7. Field Monitoring Requirements

Sampling may occur in the morning hours before schools are open or on weekdays orweekends when no school activities are expected. This will minimize the potential forpeople in the building to use water during the sampling survey. While sampling isunderway it is advisable to prohibit any persons other than the sampling team to enter


the building in order to ensure that no toilets or water outlets are being used.

7.1 Monitoring Process Design

The sampling design, described in detail in the Sampling Plan (Appendix B) is based inpart upon the 3T’s Guidance for Reducing Lead in Drinking Water in Schools:Revised Technical Guidance, December 2005; Errata to 3Ts, October 2006 (seeAppendix A).

7.2 Monitoring Methods

Equipment and supplies that will be needed to perform the sampling survey are ASTMType I reagent-grade water for the field reagent blank (FRB), latex non-colored gloves,pre-cleaned HDPE wide-mouth 250 mL single use rigid sample containers (“samplecontainer”) and chain of custody (COG forms-Appendix C or lab may use their own) andindelible ink/marker.

For sampling events where the Laboratory will collect the samples, the nitric acid canbe either added to the collection bottle at the Laboratory and prior to collection or thenitric acid can be added at the school after collection of the sample. If the watersamples are not acidified at the time of collection, the Laboratory will preserve allsamples with laboratory grade concentrated nitric acid (HNO3)to a pH of 2 standardunits (SU) or less within 48 hours of sample receipt.

Each school will have a separate sample cooler or box which will contain the fieldreagent blank (FRB) and the other samples collected. Samples will be transported byLaboratory or Samplers or appropriate representative to the Laboratory.

7.3 Field Quality Control

The analytical results obtained from the FRB will determine whether field or sampletransporting procedures is a cause of sample contamination.

Prior to the sampling event, the Sampler will collect a 250 mL ASTM Type I reagent-grade water from the Laboratory which will be used for the FRB. At the school and priorto the first sample collected at a school, the ASTM Type I reagent-grade water will betransferred into a sample container which will be identified as the FRB sample.

The ASTM Type I reagent-grade water will either be supplied by the Laboratory orpurchased through a vendor. The 250 mL sample containers are purchased precleaned. Sample containers are not to be reused.


8. Analytical Requirements

8.1 Analytical Methods

The School District must use one of the USEPA approved drinking water methods listedin the table below for the analysis of lead. Any of these methods can be used providedthat the Laboratory is certified to analyze and report lead by that method and that theLaboratory has a reporting limit no greater than 2 .ig/L.

For the purposes of the School District’s QAPP, the analytical performance informationis as follows:

Sample RecommendedAnalyte Analytical Method Matrix Guidance Level Reporting Level

Lead USEPA Method 200.8 Drinking Greater than 15 ig/L 2.0 pg/L (ppb)(Pb) USEPA Method 200.9 Water (15.5 ig/L and above)

USEPA Method 200.5 first draw (initial)SM 31 1 3B sampleASTM D3559-D

The pH of all samples must be checked at the time of receipt at the Laboratory. If the pHis not less than 2, the pH must be adjusted with the addition of nitric acid. Samples thatrequire the addition of nitric acid must sit for 16 hours prior to digestion (if applicable) oranalysis. The pH of each sample must be documented.

The turbidity of each sample must also be checked at the time of receipt at theLaboratory. If the turbidity of the sample is greater than 1 NTU, the sample must bedigested prior to analysis. The turbidity of each sample must be documented and thosesamples digested must be recorded by the Laboratory.

If a sample result exceeds 90% of the linear dynamic range, the sample must be dilutedand re-analyzed. The dilution factor must be included in the Laboratory report for eachsample that is diluted.

8.2 Analytical Quality Control

The USEPA has established protocols for the analysis of Quality Control (QC) sampleswith each analytical batch of samples, generally defined as a maximum of twentysamples. All QC results must be assessed and evaluated on an on-going basis and QCacceptance criteria must be used to determine the validity of the data.

For analytical testing, the laboratory includes positive control samples LaboratoryControl Sample (LOS) or Analytical Quality Control (AQC)] to evaluate the total


analytical system. Negative control samples (Method Blanks) are used to assess thepreparation batch for possible contamination during the preparation and processingsteps. A blank is considered contaminated with any result at or above the analytereporting limit. Specific control samples (Matrix Spikes) are used to indicate the effect ofthe sample matrix and replicates (matrix spike, LOS replicate) are performed to assessthe precision of the results generated.

Specific information regarding acceptance criteria and corrective actions is documentedin the Laboratory’s SOP for any of the analytical methods listed in the table above.

9. Sample Handling and Custody Requirements

All samples are aqueous and will be collected and labeled by the laboratory.Standard USEPA Chain of Custody (COO) procedures will be followed according to theinformation provided in the District’s Sampling Plan (Appendix B). The COO form foundin Appendix C or equivalent is to be used for this project.

Samples will be transported by Laboratory or Samplers or appropriate representative tothe Laboratory.

Sample Preservation HoldingAnalyte Volume Container (Notel) Time

unused ReagentLead 250 mL rigid plastic Grade Nitric 6 months250 mL(Pb) wide-mouth — Acid (HNO3)

clean pH < 2

Note 1. Sample preservation will be conducted either in the field or by the Laboratory upon receipt.

9.1 Sample Archive/Disposal

The samples received by the Laboratory for each school, including any digestates, willbe eligible for disposal at a minimum 30 days unless otherwise directed by the Districtafter the final report has been distributed. Samples including any digestates will not bearchived unless a written request is provided to the Laboratory.

10. Instrument/Equipment Testing, Inspection, Maintenance &Calibration Requirements

10.1 Instrument/Equipment Testing, Inspection and Maintenance


All laboratory equipment will be tested, calibrated, and maintained in accordance withexisting SOPs approved by the laboratory.

There are no field instruments anticipated for this project.

10.2 Instrument/Equipment Calibration and Frequency

The USEPA approved analytical methods for lead listed in the National Primary DrinkingWater Contaminant Regulations at 40 CFR 141 .23 and Appendix A to Subpart C requirethat the instrument calibration be performed on a daily basis.

10.3 Inspection/Acceptance of Supplies and Consumables

250 mL sample containers are purchased pre-cleaned. Sample containers are not to bereused. Sample gloves are to be disposable, non-colored and not reused.

11. Data Management

The Laboratory will immediately notify the Project Manager and Project Officer of theaffected school(s) upon receipt of any validated laboratory results that exceed the actionlevel for lead in drinking water that is greater than 15 ig/L (as defined as greater than orequal to 15.5 ig/L). For all results, the Laboratory will provide the result in microgramsper liter (ig/L) and to at least three (3) significant figures (i.e.19.6 ig/L or 20.4 ..ig/L).

The Laboratory will provide a final electronic copy of the Lead Data Report Package(LDR) for each school that will consist of: 1) PDF cover sheet that identifies the schoolname and all qualifiers with a description for that qualifier used by the laboratory, 2)laboratory report of the analytical results in PDF format, 3) the chain of custody in PDFformat and 4) an Excel spreadsheet of the results. The Excel spreadsheet must includethe information outlined in the Excel template provided in Appendix D. Informationrequired to be included in separate columns includes but is not limited to; the field ID(sample location identifier and/or code), the Laboratory sample ID, the Laboratory Nameand Laboratory certification number, whether the sample was flushed, the date and timeof collection and analysis, the analytical method, the analytical result in jig/L, thereporting limit in g/L, and whether the sample was diluted or digested and anyqualifiers.

The LDR Package will include the analytical results, appropriate qualifiers and reportinglimits for analyses of submitted samples as requested by the District. The LDR Packagemust include explanations of any relevant procedural deviations or anomaliesassociated with the sample handling and analysis of the project. This report will becompleted within the timeframe indicated in the contract. (see Section 5).


12. Assessments/Oversight

Formal field audits by QA personnel may be conducted for this project. However,identification of problems related to technical performance will be the responsibility ofthe staff working on this project.

The Project Officer(s) will assess any problem that arises in the field. If necessary,modifications to technical procedures may be considered. Any changes in technicalprocedures will be documented in the field logbook, evaluated to determine if there willbe any impact to the data and then highlighted in the Final Project Report.

The Laboratory personnel will perform self-audits and institute corrective actions inaccordance with their respective written procedures.

13. Data Review, Verification, Validation, and Usability

13.1 Data Review, Verification and Validation

The Project Manager will evaluate the School Field Sampling Summary Reports againstthe final analytical results to determine if any field observations may have contributed tolower or higher analytical results.

The Project Manager will review the analytical report and determine any limitations onthe use of the data (see Section 5.2 Bias of this QAPP) and include these limitations inthe Final Project Report.

Data review of all laboratory generated data is performed by the Laboratory QualityAssurance Officer (LQAO) who is not associated with the actual measurementoperations for the given analytical batch but knowledgeable in the analytical processesemployed. It is the responsibility of the LQAO to ensure that all data generated arecorrect and of known and documented quality. Once the review is completed, the LQAOwill sign and date the appropriate QA/QC checklist according to the Laboratory’s SOP.Any limitations on the use of data (e.g. data qualifiers) will be included in the FinalProject Report.

13.2 Reconciliation with User Requirements

As long as the Field Sampling Summary Report, LDR Package and Final Project Reportof this QAPP are satisfied, the data will be useable for the purpose intended and nofurther assessment is required. If any data are determined to be unusable by the ProjectManager, re-sampling may be required.


14. Reporting, Documents and Records

Original documents (X) will be stored as follows:

Individual School District School DistrictSchool Prolect Prolect Program

Document: Officer Manager ManagerOAPP Copy X CopyField Walk-Thru Report X Copy CopyField Logbook XChains of Custody X Copy CopyFlushing Notification! Flushing Log Tags/Procedure X Copy CopyField Sampling Summary Report X Copy Copy

. Flush Tags X Copy Copy

. Floor Diagrams X Copy Copy

. Plumbing Profile X Copy Copy

. Filter Inventory X Copy Copy

. Drinking Water Outlet inventory X Copy Copy

. Pre Sampling Water Use Certification X Copy CopyLaboratory Data Report X Copy CopyFinal Project Report Copy X Copy


Appendix A3Ts for Reducing Lead in Drinking Water in Schools:Revised Technical Guidance, December 2005; Errata to 3Ts, October 2006

Available online at:

https://www. epa .gov/sites/prod u ction/files/20 15-09/documents/toolkit leadschools guide 3ts leadschools.pdf

http://www.nj.gov/dep/watersupply/dwc-lead-schools. html


ooqo

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Attachment A - List of (Rivervale Public) SchoolsPnotitv lor Sampng

SCHOOL NAME H&drurn

Add lOWS US I1PPdP(I

:1 HAlLWAY NI V! GYM U9 VVATL RCOOLER

_____

DATE OF

SAMPUNG

HI-lW 93-WC- 1

CE RUfl EDLABORATORY

NOTES

2ND HALLWAY NEW GYM 93 WATERCOOLER

H-I-IW-93-WC-2

3° MUSIC R00M1163 SINKH -C L-63-S

41H HALLWAY#56 WATER COOLERH-HW-•56-WC

5TF NURSE OFFICE ROOM#SO

6TI HALLWAY #14 WATER COOLERH-HW-14-WC

7 FACULTY ROOM#12 SINKH-FR- 12-S I N K


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ains

4.W

ithw

hat

mat

eria

lsis

the

serv

ice

conn

ecti

on(t

hepi

peM

ater

ial:

ST

EE

Lth

atca

rrie

sw

ater

toth

esc

hool

from

the

publ

icw

ater

syst

em’s

mai

nin

the

stre

et)

mad

e?L

ocat

ion:

ST

OR

AG

ER

OO

M95

Wher

eis

the

Ser

vice

Lin

elo

cate

d?(T

his

isth

eP

OE

loca

tion

.)5.

Isth

ere

poin

tof

entr

y(P

OE

)or

poin

tof

use

(PO

U)

Yes

Typ

e:E

lkay

wat

erfi

lter

trea

tmen

tin

use

?L

ocat

ion:

1V

ersi

on1.1

July

21,

2016

(NJD

EP)

6.A

reth

ere

tanks

inyo

urpl

umbi

ngsy

stem

(pre

ssure

tank

s,Y

IN

grav

ity

stora

ge

tanks)

?

7.D

oes

the

scho

olha

vea

filte

rm

ainte

nan

cean

dop

erat

ion

YE

Spr

ogra

m?

Ifso

,w

hois

resp

onsi

ble

for

this

prog

ram

?D

IRE

CT

OR

OF

BU

ILD

ING

SA

ND

GR

OU

ND

SW

hat

isth

epr

oces

sfo

rad

ding

filt

ers?

8.H

ave

acce

ssib

lesc

reen

sor

aera

tors

onou

tlet

sth

atY

espr

ovid

edr

inki

ngw

ater

bee

ncl

eaned

?D

oes

the

scho

olha

vea

scre

enor

aera

tor

mai

nte

nan

ceA

snee

ded

prog

ram

?9.

Hav

eth

ere

bee

nan

yco

mpl

aint

sab

out

bad

(met

alli

c)—

YI

Nta

ste?

Not

elo

cati

on(s

).L

ocat

ion:

10.

Rev

iew

reco

rds

and

cons

ult

with

the

publ

icw

ater

supp

lier

todet

erm

ine

whet

her

any

wat

ersa

mple

sha

vebee

nta

ken

inth

ebu

ildi

ngfo

ran

yco

ntam

inan

ts.

Ifso

,id

entif

y:.

Nam

eof

cont

amin

ant(

s).

Conce

ntr

atio

ns

foun

d.

pHle

vel

Iste

stin

gdone

regu

larl

yat

the

buil

ding

?Y

ES

LE

AD

INW

AT

ER

11.

Oth

erpl

umbi

ngba

ckgr

ound

ques

tions

incl

ude:

.A

rebl

uepr

ints

ofth

ebu

ildi

ngav

aila

ble?

NO

.A

reth

ere

know

npl

umbi

ng“d

ead-

ends

”,lo

wuse

area

s,ex

isti

ngle

aks

orot

her

“pro

blem

area

s”?

NO

Are

reno

vati

ons

plan

ned

for

any

ofth

epl

umbi

ngsy

stem

?N

O

Ques

tioii

sA

nsw

ers

V____

F.

Ver

sion

1.1

Ju’y

21,

2016

(NJD

EP)

roU

est

jofi

sA

nsw

ers

Wal

k-T

hrou

ghT

hese

ques

tion

ssh

ould

be

addre

ssed

duri

ngth

ew

alk-

thro

ugh

ofth

efa

cilit

y,w

hile

Att

achm

ent

C-

Dri

nkin

gW

ater

Out

let

Inve

ntor

yis

bein

gco

rnp!

ered

w

1.C

onfi

rmth

em

ater

ial

ofS

ervi

ceL

ine

visu

ally

.2.

Con

firm

the

pre

sence

ofP

OE

orPO

Utr

eatm

ent.

3.W

hat

are

the

pota

ble

wat

erpi

pes

mad

eof

inyo

urfa

ciU

ty?

CO

PP

ER

.L

ead

eP

last

ice

Gal

vani

zed

Met

al•

Cas

tIr

one

Copper

.O

ther

Not

eth

ew

ater

flow

thro

ugh

the

buil

ding

and

the

area

sth

atre

ceiv

ew

ater

firs

t,an

dw

hich

area

sre

ceiv

ew

ater

last

.4.

Are

elec

tric

alw

ires

gro

unded

toW

ater

Pip

es?

Y/

NN

ote

loca

tion

(s).

Loc

atio

n:5.A

rebra

ssfi

tting

s,fa

uce

ts,

orva

lves

use

din

your

drin

king

Com

plet

ein

“Bra

ss”

Col

umn

inA

ttac

hmen

tC

-\‘

Vet

erO

utle

tIn

vent

ory.

wat

ersy

stem

?N

ote

that

mos

tfa

uce

tsar

ebra

sson

the

insi

de.

Doc

umen

tth

elo

cati

ons

ofan

ybra

ssw

ater

outl

etto

besa

mple

d.

6.L

ocat

eal

ldr

inki

ngw

ater

outl

ets

(i.e

.w

ater

cool

ers,

Com

plet

ein

Att

achm

ent

C-W

ater

Out

let

Inve

ntor

y.bu

bble

rs,

ice

mac

hine

s,ki

tche

n!fo

odpr

epsi

nks,

etc.

)in

the

faci

lity.

3V

ersi

on1.

1Ju

ly21

,20

16(N

JDEP

)

Ques

tions

Answ

ers

Lt

7.H

ave

the

bran

dsan

dm

odel

sof

the

wat

erco

oler

sin

the

YI

Nsc

hool

been

com

pare

dto

the

list

ofre

call

edw

ater

cool

ers

inth

eT

oolk

it?

Rec

alle

dD

rink

ing

Wat

erF

ount

ains

Mak

ean

dM

od&

Typ

e8.

Hav

esi

gns

ofco

rros

ion,

such

asfr

eque

ntle

aks,

rust

-C

ompl

ete

in“S

igns

ofC

orro

sion

’co

lum

nin

Att

achm

ent

C-

Dri

nkin

gco

lore

dw

ater

,or

stai

ned

fixt

ures

,di

shes

,or

laun

dry

been

Wat

erO

utle

tIn

vent

ory.

det

ecte

d?

Not

eth

elo

cati

ons

ofw

ater

outl

ets.

9.A

reth

ere

any

outl

ets

that

are

not

oper

atio

nal

and

Y./

Nth

eref

ore

out

ofse

rvic

e?P

erm

anen

tly?

Tem

pora

rily

?C

ompl

ete

“Ope

rati

onal

Col

umn”

inA

ttac

hmen

tC

-D

rink

ing

Wat

erO

utle

tIn

vent

ory.

Typ

e)L

ocat

ion

Des

crip

tion

Per

man

entl

y

Tem

pora

rily

Ver

sion

1.1Ju

ly21

, 201

6(N

JDEP

)

Att

achm

ent

B.i:

Plu

mng

Pro

file

Inst

ruct

ions

Plum

bing

Prof

ileQ

uest

ions

Wha

t You

rAns

wer

sto

the

Plum

bing

Prof

ileQ

uest

ions

Mea

nTh

equ

estio

nsin

this

colu

mn

will

help

you

This

colu

mn

disc

usse

sth

esi

gnifi

canc

eof

poss

ible

answ

ers

toth

epl

umbi

ngpr

oqu

est’

os.

dete

rmin

ew

heth

erle

adis

likel

yto

bea

prob

lem

inyo

urfa

cility

,an

dwi

llen

able

you

topr

iorit

ize

your

sam

plin

gef

fort.

Bac

kgro

und

Info

rmat

ion

1W

hen

was

the

ongi

nal

build

ing

cons

truct

ed’?

Old

erB

uild

ings

—Th

roug

hth

eea

rly19

00s

lead

ploe

sw

ere

com

mon

lyus

edfo

rnte

rorD

iim

Lig

’ce

rtain

part

sof

the

coun

tryin

publ

icbu

ildin

gsan

dpr

ivat

eho

mes

,Pl

umbi

ngin

stae

dbe

fore

1930

ism

ore

Wer

ean

ybu

ildin

gsor

addi

tions

adde

dto

the

orig

inal

likely

toco

ntai

nle

adth

anne

wer

pipe

s.Be

twee

n19

20an

d19

50,g

alva

nize

dpi

pes

wer

eal

sous

edfo

rfac

ility’

?If

so, c

ompl

ete

ase

para

tepl

umbi

ngpr

ofile

plum

bing

.Af

ter19

30, c

oppe

r gen

eral

lyre

plac

edle

adas

the

mos

tcom

mon

lyus

edm

ater

ialf

rw

ater

for e

ach

build

ing,

addi

tion,

orw

ing.

pipe

s.U

pun

tilth

em

id-

tola

te-i

980s

(unt

ilth

ele

ad-f

ree

requ

irem

ents

ofth

e19

86Sa

feD

rinki

ngW

ater

Act

Am

endm

ents

took

effe

ct),

lead

sold

erw

asty

pica

llyus

edto

join

thes

eco

pper

pipe

s.Th

eef

fortS

ofyo

urpu

blic

wat

ersu

pplie

r ove

rthe

year

sto

min

imiz

eth

eco

rros

iven

ess

ofth

ew

ater

may

have

resu

edr

min

eral

depo

sits

form

ing

aco

atin

gon

the

insi

deof

the

wat

erpi

pes

(pas

siva

ton)

.Th

isco

ang

insu

late

sth

ew

ater

from

the

plum

bing

and

resu

ltsin

decr

ease

dle

adle

vels

inw

ater

.if

the

ccah

ngdo

esno

t.estr

isdi

stur

bed,

the

wat

eris

indi

rect

cont

act w

ithan

yle

adin

the

plum

bing

syst

em.

New

erB

uild

ings

—N

ewbu

ildin

gsar

eno

tlik

elyto

have

lead

pipe

sin

thei

rpl

umbi

ngsy

stem

s,bu

tthe

yar

eve

rylik

ely

toha

veco

pper

pipe

swi

thso

lder

join

ts.

Bui

ldin

gsco

nstru

cted

prio

rto

the

late

i9SO

s,be

fore

the

lead

-fre

ere

quir

emen

tsof

the

1986

Safe

Drin

king

Wat

erA

ctA

men

dmen

ts,

may

have

iots

mad

eof

lead

sold

er.

Bui

ldin

gsco

nstru

cted

afte

r thi

spe

riod

shou

ldha

vejo

ints

mad

eof

lead

iree

sold

ers.

Even

ifle

ad-f

ree”

mat

eria

lsw

ere

used

inne

wco

nstru

ctio

nan

d/or

pium

bing

repa

irs,

sad

____

____

____

____

____

____

____

____

_

leac

hing

may

occu

r.

5V

ersi

on1.

1Ju

ly21

,20

16(N

JDEP

)

‘F-

Plum

bing

Prof

ileQ

uest

ions

2.If

built

orre

paire

daf

ter

1986

, wer

ele

ad-f

ree

plum

bing

and

sold

erus

edin

acco

rdan

cewi

thth

ele

ad-f

ree

requ

irem

ents

ofth

e19

86Sa

feD

rinki

ngW

ater

Act

Am

endm

ents

?W

hatt

ype

ofso

lder

has

been

used

?

Was

lead

sold

erus

edin

your

plum

bing

syst

em?

Not

eth

elo

catio

nsof

lead

sold

er.

3.W

hen

wer

eth

em

ostr

ecen

t plu

mbi

ngre

pairs

and

repl

acem

ents

mad

e(n

ote

loca

tions

)?

4.W

ithw

hatm

ater

ials

isth

ese

rvic

eco

nnec

tion

(the

pipe

that

carr

ies

wat

erto

the

scho

olfro

mth

epu

blic

wat

ersy

stem

’sm

ain

inth

est

reet

)m

ade?

Not

eth

elo

catio

nw

here

the

serv

ice

conn

ectio

nen

ters

the

build

ing

and

conn

ects

toth

ein

terio

rpl

umbi

ng.

(Thi

sis

the

POE

loca

tion)

Wha

tYou

rAns

wer

sto

the

Plum

bing

Prof

i!eQ

uest

ions

Mea

nTh

e19

86A

men

dmen

tsto

the

Safe

Drin

king

Wat

erA

ctba

nned

plum

bing

com

pone

nts

tflat

conte

ed

elev

ated

leve

lsof

lead

.Le

ad-f

ree

sold

eran

dflu

x(n

otm

ore

than

0.2%

lead

)an

dpi

pe,

pipe

ttir

5,ni

fixtu

res

(not

mor

eth

an8%

lead

)m

ustn

owbe

used

.Th

ele

achi

ngpo

tent

ial

ofle

ad-f

ree

(ie

tin-

antim

ony)

sold

eris

muc

hle

ssth

anle

adso

lder

,Th

ele

achi

ngpo

tent

ialo

flea

d-fr

eepb

e,cp

efix

ture

sis

also

less

,bu

tlea

chin

gis

still

poss

ible

.

Ifle

ad-f

ree

mat

eria

lsw

ere

notu

sed

inne

wco

nstru

ctio

nan

d/or

plum

bing

repa

irs,

elev

ated

lead

e’.’e

isca

nbe

prod

uced

.If

the

film

resu

lting

from

pass

ivat

ion

does

note

xist

orha

sno

tyet

adeq

ua.te

’yfo

rmed

,an

yea

that

ispr

esen

tis

indi

rect

cont

actw

ithth

ew

ater

.

Inso

me

area

sof

the

coun

try,

itis

poss

ible

that

high

-lead

mat

eria

lsw

ere

used

until

1988

oriD

erha

psev

enla

ter.

You

rlo

calp

lum

bing

code

auth

ority

orbu

ildin

gin

spec

tor

may

beab

leto

prov

ide

guid

ance

rege

rc1r

whe

nhi

gh-le

adm

ater

ials

wer

ela

stus

edon

are

gula

rba

sis

inyo

urar

ea.

Cor

rosi

onoc

curs

(1)

asa

reac

tion

betw

een

the

wat

eran

dth

epi

pes

and

(2)

-asa

reac

tion

betw

een

the

copp

eran

dso

lder

(met

al-to

-met

al).

This

latte

rre

actio

nis

know

nas

galv

anic

corr

osio

nw

hich

can

bevi

goro

usin

new

pipi

ng.

Ifle

adso

lder

sw

ere

used

inth

epi

ping

orif

bras

sfa

ucet

s,va

lves

,an

dfit

tings

cont

aini

ngal

loys

ofle

adw

ere

inst

alle

d(s

eere

spon

seto

Wal

kTh

roug

hQ

uesh

on5

belo

wfo

rfur

ther

disc

ussi

onof

bras

s,le

adle

vels

inth

ew

ater

may

behi

gh.

Afte

rab

out 5

year

s,ho

wev

er,

this

type

ofre

actio

n(g

alva

nic

corr

osio

n)sl

ows

dow

nan

dle

adge

tsin

tow

ater

mai

nly

asa

resu

ltof

wat

erbe

ing

corr

osiv

e.If

the

wat

eris

non-

corr

osiv

e,pa

ssiv

atio

nis

likel

yto

have

occu

rred

end

toha

vere

duce

dop

portu

nitie

sfo

rlea

dto

geti

nto

the

wat

ersy

stem

.

For t

hese

reas

ons,

f the

build

ing

(or

anad

ditio

n,ne

wpl

umbi

ng,o

rre

pair)

isle

ssth

an5

year

scd

and

lead

sold

eror

othe

rm

ater

ials

(e.g

.,br

ass

fauc

ets

cont

aini

ngle

adal

loys

)w

ere

used

,yo

um

ayha

veel

evat

edle

adle

vels

,If

wat

ersu

pplie

dto

the

build

ing

isco

rros

ive,

lead

can

rem

ain

apr

oble

mre

oard

less

ofth

epl

umbi

ng’s

age.

Lead

pipi

ngw

asof

ten

used

for

the

serv

ice

conn

ectio

nsth

atjo

inbu

ildin

gsto

publ

icw

ater

syst

ems.

The

serv

ice

conn

ectio

nis

the

pipe

that

carr

ies

drin

king

wat

erfro

ma

publ

icw

ater

mai

nto

abu

lldng

.So

me

loca

litie

sac

tual

lyre

quire

dth

eus

eof

lead

serv

ice

conn

ectio

nsup

until

the

lead

-fre

ere

quir

emen

tsof

the

1986

Safe

Drin

king

Wat

erA

ctA

men

dmen

tsto

okef

fect

.A

lthou

gha

prot

ectiv

ela

yerin

gof

min

eral

sm

ayha

vefo

rmed

onth

ese

pipe

s,vi

brat

ions

can

caus

efla

king

ofan

ypr

otec

tive

build

-up

and,

liw

ing

sari

cont

amin

atio

nto

occu

r.

6V

ersi

on1.1

July

21,

2016

(NJD

EP)

Wha

tYou

r Ans

wer

sto

the

Plum

bing

Prof

fleQ

uest

ions

Mea

n5.

Isth

ere

poin

t of e

ntry

(PO

E)or

poin

tof u

se(P

OU

)A

reth

ere

wat

ertr

eatm

ent

units

inyo

urpl

umbi

ngsy

stem

?T

reat

men

tuni

tsco

uld

be,

but a

reno

ted

totr

eatm

ent i

nus

e?io

nex

chan

geun

its,

filte

rcar

tridg

e,re

serv

eos

mos

is,

etc.

6.D

oyo

uha

veta

nks

inyo

urpl

umbi

ngsy

stem

Som

eol

der

tank

sm

ayco

ntai

nco

atin

gsth

atar

ehi

ghin

lead

cont

ent.

(pre

ssur

eta

nks,

grav

ityst

orag

eta

nks)

?Ta

nks

may

accu

mul

ate

sedi

men

tth

atco

uld

beflu

shed

back

into

the

plum

bing

syst

emun

der

cert&

nN

ote

the

loca

tion

ofan

yta

nks,

and

any

avai

labl

eci

rcum

stan

ces.

You

may

wish

toco

ntac

t the

supp

lier o

rm

anuf

actu

rer

toob

tain

info

rmab

onab

out

coe’

ns.

info

rmat

ion

abou

t the

tank

;e.

g.,

man

ufac

ture

r,da

teof

You

may

also

wish

tohi

rea

plum

ber o

r tan

kse

rvic

eco

ntra

ctor

toin

spec

tyou

rta

nks,

espec

iyar

a:ty

inst

alla

tion,

stor

age

tank

sth

atar

elo

cate

dou

tsid

eof

the

build

ing.

7.D

oes

the

scho

olha

vea

filte

rm

aint

enan

cean

dA

prog

ram

for t

hem

aint

enan

cean

dth

eup

keep

offil

ters

ondr

inki

ngw

ater

ouet

sis

nece

ssar

yto

ensu

rerr

.eop

erat

ion

prog

ram

?ef

fect

iven

ess

ofth

efil

ters

.M

ostf

ilter

sre

com

men

dre

plac

emen

tafte

rsix

mon

ths.

Ifth

efU

ters

need

Ifso

,who

isre

spon

sibl

efo

r thi

spr

ogra

m?

repl

acem

ent e

very

sixm

onth

s,th

epr

ogra

mwi

llin

clud

ea

proc

edur

efo

ren

surin

gth

atev

eryx

mor

old

Wha

t is

the

proc

ess

for a

ddin

gfil

ters

?fil

ter i

sre

plac

ed.A

nin

divi

dual

shou

ldbe

resp

onsi

ble

for

ensu

ring

that

this

fter

mat

enan

cepr

ogra

mis

follo

wed

.

Ifth

esc

hool

wou

ldlik

eto

add

afil

ter t

oa

wat

erou

tlet,

wha

t is

the

proc

ess?

Doe

sa

requ

est0rrn

haa

tobe

com

plet

edan

dsu

bmitt

edto

the

indi

vidu

alin

char

geof

mai

nten

ance

?D

ciI

fier

sne

edto

bead

ded

ata

certa

intim

eof

year

tofo

llow

the

mai

nten

ance

prog

ram

?8.

Do

outle

tsth

atpr

ovid

edr

inki

ngw

ater

have

Lead

-con

tain

ing

sedi

men

tsth

atar

etra

pped

onsc

reen

sca

nbe

asi

gnifl

cant

sour

ceof

lead

cont

amin

aon

acce

ssib

lesc

reen

sor

aera

tors

?(S

tand

ard

fauc

ets

Sedi

men

tssh

ould

bete

sted

for t

hepr

esen

ceof

lead

,an

dyo

urfa

cilit

ysh

ould

crea

tea

rout

ine

man

tena

n.oe

usua

llyha

vesc

reen

s.M

any

cool

ers

and

bubb

lers

prog

ram

tocl

ean

the

scre

ens

freq

uent

ly.

Ifse

dim

ent

has

been

are

occu

rrin

gpr

oble

mre

gula

rc’

eangf

also

have

scre

ens.

)N

ote

the

loca

tions

,th

esc

reen

san

dad

ditio

nal

inve

stig

atin

gin

tow

hyth

ede

bris

isac

cum

ulat

ing

isap

prop

riate

,H

.cvi

ever

,th

em

anuf

actu

rer

orw

ater

serv

ice

prov

ider

shou

ldbe

cont

acte

dto

obta

inin

stru

ctio

ns.

Hav

eth

ese

scre

ens

been

clea

ned?

Not

eth

elo

catio

ns.

9.H

ave

ther

ebe

enan

yco

mpl

aint

sab

out w

ater

tast

eA

lthou

ghyo

uca

nnot

see,

tast

e,or

smel

lle

addi

ssol

ved

inw

ater

,th

epr

esen

ceof

am

etal

cta

ste

orru

sty

(met

allic

,et

c.)

orru

sty

appe

aran

ce?

Not

eth

eap

pear

ance

may

indi

cate

corr

osio

nan

dpo

ssib

lele

adco

ntam

inat

ion.

loca

tions

.

Plum

bing

Prof

ileQ

uest

ions

7V

ersi

on1.1

July

21,

2016

(NJD

EP)

Plum

bing

Prof

ileQ

uest

ions

Wha

tYou

rA

nsw

ers

toth

ePl

umbi

ngPr

ofile

Que

stio

nsM

ean

10

.C

heck

buil

din

gfi

les

todete

rmin

ew

heth

er

any

Lead

test

ing

may

hav

ep

rev

iou

sly

been

do

ne

vo

lun

tari

lyunder

the

Lead

Con

iam

naon

Ccn

roA

ctw

ate

rsa

mp

les

hav

ebeen

tak

en

from

yo

ur

buil

din

gfo

rR

esu

lts

of

analy

ses

of

gen

era

lw

ate

rqual

ity,

such

as

measu

res

of

pH,

calc

ium

hard

ness

,an

dca

rbc,

teany

con

tam

inan

ts(a

lso

ch

eck

wit

hyour

publi

cw

ate

ral

kal

init

y,

can

pro

vid

eim

po

rtan

tclu

es

ab

ou

tth

ecorr

osi

veness

of

the

wat

er.

Gen

eray

.th

ehber

tnsu

pp

lier)

,valu

es

of

these

para

mete

rs,

the

less

likel

yit

isth

at

your

wate

ris

co

rro

siv

e.

ifo

uha

;eno

data

frrn

your

sch

oo

l,y

ou

rp

ub

lic

wate

rsy

stem

should

at

least

be

able

topr

ovid

ein

form

aon

abou

tth

ege

nera

lw

ater

.N

am

eo

fco

nta

min

ant(

s)?

qual

ity.

.W

hat

concen

trati

ons

of

these

conta

min

ants

were

fou

nd

?

.W

hat

was

the

pH

level

of

the

wate

r?

.Is

_te

stin

g_

do

ne_

regula

rly_at

_your

faci

lity

?

11

.O

ther

plu

mb

ing

quest

ions:

You

sho

uld

incorp

ora

teth

isin

form

ati

on

into

decis

ion

sre

gard

ing

sam

ple

locao

ns

and

sam

p’g

prc

toc.c

.Y

oum

ayw

ishto

note

the

dire

ctio

nof

wat

erflo

wan

dth

elo

catio

nof

fixtu

res,

va’e

s,ta

cks,

area

sof

sem

enr

.A

reblu

epri

nts

of

the

buil

din

gav

ail

ab

le?

accum

ula

tion,

are

as

of

co

rro

sio

n,

etc

.,on

ask

etc

hor

blue

prin

t oft

hepl

umbg

..

Are

there

kn

ow

np

lum

bin

g“dead’

ends,

”ow

use

are

as,

ex

isti

ng

leak

sor

oth

er

“pro

ble

m

are

as”

?

.A

rere

novati

on

sbein

gp

lan

ned

for

part

or

all

of

the_

plu

mb

ing

_sy

stem

?

Wal

k-Th

roug

h

1.C

on

firm

the

mat

eria

ltha

t the

serv

ice

line

isSe

eB

ackg

roun

dIn

form

atio

nQ

uest

ion

#4.

mad

eof

visu

ally

2,

Co

nfi

rmth

ep

rese

nce

of

POE

or

POU

See

Back

gro

un

dIn

form

ati

on

Qu

est

ion

#5tr

eatm

ent.

8V

ersi

on1.

1Ju

ly21

,20

16(N

JDEP

)

Wha

tYou

rA

nsw

ers

toth

ePl

umbi

ngPr

ofile

Que

stio

nsM

ean

Surv

eyyo

urbu

ildin

gfo

r exp

osed

pipe

s,pr

efer

ably

acco

mpa

nied

byan

expe

rien

ced

plum

ber

who

sho;i

ccab

leto

read

ilyid

entif

yth

eco

mpo

sitio

nof

pipe

son

site

.M

ostb

ud!n

gsha

vea

com

bheo

nof

dfe

ren

plum

bing

mat

eria

ls:

•Le

adpi

pes

are

dull

gray

inco

lor

and

may

beea

sily

scra

tche

dby

anobct

such

asa

kn’e

oLe

adpi

pes

are

am

ajor

sour

ceof

lead

cont

amin

atio

nin

drin

king

wat

er,

•G

alva

nize

dm

etal

pipe

sar

egr

ayor

silv

er-g

ray

inco

lor

and

are

usua

lly.tt

edto

geth

erw

hth

read

edjo

ints

.In

som

ein

stan

ces,

com

poun

dsco

ntai

ning

lead

have

been

used

tose

&th

eth

read

scng

the

pipe

s.D

ebris

from

this

mat

eria

l,w

hich

has

falle

nin

side

the

pipe

s,m

aybe

aso

urce

ofco

ntam

inat

ion.

•C

oppe

rpi

pes

are

red-

brow

nin

colo

r.C

orro

ded

porti

ons

may

show

gree

nde

posi

ts.

Cop

rejo

ints

wer

ety

pica

llyjo

ined

toge

ther

with

lead

sold

ers

until

the

lead

-fre

ere

quir

er.e

nts

ofth

e‘

Safe

Drin

king

Wat

erA

ctA

men

dmen

tsto

okef

fect

.

•Pl

astic

pipe

s,es

peci

ally

thos

em

anuf

actu

red

abro

ad,

may

cont

ain

lead

,If

pls

icpi

pes

reus

ed.

besu

reth

eym

eet

NSF

Inte

rnat

iona

lst

anda

rds.

(Not

e:N

SFIn

tern

atio

nal i

san

lode

perd

ant.

third

-pa

rty

test

ing

orga

niza

tion.

Prod

uctl

istin

gsca

nbe

obta

ined

byvi

sitin

gth

eir

Web

s/fe

atht

tp://

ww

w.n

sf.o

rg/b

usin

ess/

sear

ch_l

istin

gs/in

deas

p.)

Ifel

ectri

cale

quip

men

t,su

chas

tele

phon

es,

has

been

inst

alle

dus

ing

wat

erpi

pes

asa

grou

nd,t

hee!

ectri

ccu

rren

t tra

velin

gth

roug

hth

egr

ound

wire

will

acce

lera

teth

eco

rros

ion

ofan

yin

terio

rpl

umbi

ngco

nta

ng

lead

.Th

epr

actic

esh

ould

beav

oide

d,if

poss

ible

.H

owev

er,

ifex

istin

gw

ires

are

alre

ady

grou

nded

tow

ater

pipe

s,th

ew

ires

shou

ldno

tbe

rem

oved

from

the

pipe

sun

less

aqu

alifi

edel

ectri

cian

inst

alls

aet

erne

t’Je

grou

ndin

gsy

stem

.C

heck

with

your

loca

lbu

ildin

gin

spec

toro

nth

ism

atte

r.Y

our

stat

eor

iOC

9‘

code

may

requ

iregr

ound

ing

ofth

ew

ires

toth

ew

ater

pipe

s.Im

prop

ergr

ound

ngof

elec

trica

leum

.et

may

caus

esev

eres

hock

.

-

--_______

Plum

bing

Prof

ileQ

uest

ions

3.Sp

ecifi

cally

, wha

tare

the

pota

ble

wat

erpi

pes

mad

eof

inyo

urfa

cilit

y(n

ote

the

loca

tions

)?

•Le

ad•

Plas

tic•

Gal

vani

zed

Met

al•

Cas

tIro

n•

Cop

per

•O

ther

Not

eth

elo

catio

nof

the

diff

eren

t typ

esof

pipe

,if

appl

icab

le,

and

the

dire

ctio

nof

wat

erflo

wth

roug

hth

ebu

ildin

g.N

ote

the

area

sof

the

build

ing

that

rece

ive

wat

erfir

st,an

dw

hich

area

sre

ceiv

ew

ater

last

.

4.Is

any

elec

trica

leq

uipm

ent g

roun

ded

tow

ater

pipe

s?N

ote

the

loca

tions

.

9V

ersi

on1.

1Ju

ly21

,20

16(N

JDEP

)

F.

Wha

tYou

rA

nsw

ers

toth

ePl

umbi

ngPr

ofile

Que

stio

nsM

ean

_____

Bra

ssfit

tings

,fau

cets

,an

dva

lves

are

gold

enye

llow

inco

lor,

sim

ilart

oco

pper

inap

pear

ance

,or

are

p1at

ew

ithch

rom

e.B

rass

isco

mpo

sed

prim

arily

oftw

om

etal

s,co

pper

and

zinc

.M

ostb

rass

esco

ntai

nle

adrr

:nq

from

2pe

rcen

t to

8pe

rcen

t.Th

atle

adca

nco

ntam

inat

eth

ew

ater

cont

acts

urf

ace

whe

nit

issm

eare

dn

the

mac

hine

dsu

rfac

esdu

ring

prod

uctio

n.A

fter

1996

,br

ass

fittin

gsin

stal

led

indr

inki

ngw

ater

oute

t5su

chfa

ucet

san

dw

ater

cool

ers

mus

tm

eet N

SFst

anda

rds

for

lead

cont

ent.

Whi

lem

ispe

rcen

tage

ico

ns:d

ere

lead

-fre

eun

der

the

1986

Safe

Drin

king

Wat

erA

ctA

men

dmen

ts,

som

eco

ntam

inat

ion

prob

ems

sti

may

occu

r,O

lder

bras

sfa

ucet

sm

ayco

ntai

nhi

gher

perc

enta

ges

ofle

adan

dle

adso

lder

inth

eir

inte

rior

cons

truct

ion

and

pose

cont

amin

atio

npr

oble

ms.

Not

eth

atyo

urst

ate

orlo

cal

gove

rnm

ent

may

have

impo

sed

this

stan

dard

prio

rto

1988

.

The

degr

eeto

whi

chle

adwi

llle

ach

from

bras

spr

oduc

tsco

ntai

ning

allo

yswi

thle

ssth

an8

perc

ent

lead

isde

pend

ent u

pon

the

corr

osiv

enes

sof

the

wat

eran

dth

em

anuf

actu

ring

proc

ess

used

tode

v&op

the

prod

uct.

Ast

udy

reve

aled

that

fabr

icat

edfa

ucet

ste

ndto

cont

ribut

ele

ssle

adto

the

wat

erth

anfa

ucet

sm

anuf

actu

red

byth

epe

rman

ent m

old

proc

ess,

rega

rdle

ssof

the

amou

ntof

lead

inth

eal

loy.

Inre

spon

seto

are

quir

emen

t oft

he19

96SD

WA

,EP

Aw

orke

dw

ithth

epl

umbi

ngin

dust

ryan

dN

SFIn

tern

atio

nal

tode

velo

pa

volu

ntar

yin

dust

ryst

anda

rdth

atis

desi

gned

tom

inim

ize

the

amou

nts

ofle

adbng

leac

hed

from

thes

epr

oduc

ts.T

his

stan

dard

isN

SF/A

NSI

Stan

dard

61,

Sect

ion

9.Si

nce

1 99E

.,all

plim

big

fixtu

res

for

use

asdr

inki

ngw

ater

supp

lym

ust

mee

tthi

sst

anda

rd.

You

shou

ldre

quire

NSF

!AN

SI51

certi

ficat

ion

onall

drin

king

wat

ersy

stem

prod

ucts

purc

hase

d.In

clud

ea

copy

ofth

eN

SF! A

NSI

61ce

rtific

ate

asa

requ

irem

ent o

nyo

urpu

rcha

seor

ders

.Th

edi

strib

utor

orm

anuf

actu

rer

can

prov

ide

you

with

alis

t of

certI

fied

prod

ucts

.Y

oush

ould

requ

ireN

SF/A

NSI

61ce

rtific

atio

non

alldr

inki

ngw

ater

syst

empr

oduc

tsus

edr

new

cons

truct

ion

and

info

rmyo

urar

chite

cts

and

revi

seyo

urbu

ildin

gsp

ecifi

catio

ns.

Plum

bing

Prof

ileQ

uest

ions

_______

5.A

rebr

ass

fittin

gs,f

auce

ts, o

rva

lves

used

inyo

urdr

inki

ngw

ater

syst

em?

(Not

e:M

ostf

auce

tsar

ebr

ass

onth

ein

side

.)

You

may

wan

tto

note

the

loca

tions

ona

map

ordi

agra

mof

your

faci

lity

and

mak

eex

tens

ive

note

sth

atw

ould

faci

litat

efu

ture

anal

ysis

ofle

adsa

mpl

ere

sults

.

6.H

owm

any

ofth

efo

llow

ing

outle

tspr

ovid

ew

ater

Inad

ditio

nto

lead

com

pone

nts

inth

epl

umbi

ngsy

stem

,le

adso

lder

sor

lead

inth

ebr

ass

fittin

gsan

dV

CIV

CS

forc

onsu

mpt

ion?

Not

eth

elo

catio

ns,

used

inso

me

taps

,bu

bble

rs,

and

refr

iger

ated

wat

erco

oler

sm

aybe

sour

ces

ofle

ad.

Itis

impo

rtant

toid

entif

yth

elo

catio

nsof

allsu

chdr

inki

ngw

ater

outle

ts.

Fauc

ets

inre

stro

oms

shou

ldno

t be

used

toob

tain

.W

ater

Coo

lers

wat

erfo

rdrin

king

.A

lthou

ghth

eym

aybe

adeq

uate

forw

ashi

ngha

nds,

they

may

notb

eap

prop

riate

for

.B

ubbl

ers

drin

king

purp

oses

.Y

oum

ayco

nsid

erpo

stin

g“d

ono

tdrin

ksi

gns.

.Ic

eM

aker

s.

Kitc

hen

Tap

s.

Drin

king

_Fou

ntai

nsor

_Tap

s

10V

ersi

on1.

1Ju

ly21

,20

16(N

JDE

P)

Plum

bing

Prof

ileQ

uest

ions

7.H

asyo

ursc

hool

chec

ked

the

bran

dsan

dm

odel

sof

wat

erco

oler

san

dco

mpa

red

them

toth

elis

t of

reca

lled

wat

erco

oler

sin

App

endi

xH.

iN

ote

the

loca

tions

ofan

yre

calle

dco

oler

s.

8.A

reth

ere

any

sign

sof

corr

osio

n,su

chas

freq

uent

leak

s,ru

st-c

olor

edw

ater

,or

stai

ned

dish

esor

laun

dry?

Not

eth

elo

catio

ns.

9.A

reth

ere

any

outle

tsth

atar

eno

t ope

ratio

nal

and

ther

efor

eou

t of s

ervi

ce?

Perm

anen

tly?

Tem

pora

rily?

Wha

t You

rA

nsw

ers

toth

ePl

umbi

ngPr

ofile

Que

stio

nsM

ean

Wat

erco

oler

sm

aybe

am

ajor

sour

ceof

lead

cont

amin

atio

n.Th

eFe

dera

lC

onsu

mer

Prod

uct

Safe

tyC

omm

issi

onne

gotia

ted

anag

reem

ent w

ithH

alse

yTa

ylor

thro

ugh

aco

nsen

tor

der

agre

emen

tpu

bshe

dn

June

1990

topr

ovid

ea

repl

acem

ent o

rre

fund

prog

ram

that

addr

esse

sall

the

wat

ercc

oers

‘ste

dby

EPA

asha

ving

lead

-line

dta

nks,

Hal

sey

Tayl

orw

asth

eOf

liVco

mpa

nyid

entie

dby

EPA

asm

anuf

actu

rng

me

wat

erco

oler

swi

thle

ad-li

ned

tank

s.A

ddio

nally

,so

me

cool

ers

man

ufac

ture

dby

EEO

Cha

da

valv

ean

don

eso

lder

edjo

int t

hatc

onta

ined

lead

,

See

Atta

chm

ent H

,iof

this

docu

men

t for

asu

mm

ary

ofEP

A’s

list o

fwat

erco

oler

sfo

und

toco

nta

lead

Use

the

list t

ohe

lppr

iorit

ize

your

sam

plin

g.If

your

wat

erco

oler

islis

ted

ashan

ga

lead

-lfrie

dta

nk,

you

shou

ldno

tuse

the

wat

erfo

rdrin

king

,an

dyo

ush

ould

rem

ove

the

cool

erim

med

atel

yas

thes

eco

oier

spo

seth

ehi

ghes

tris

kof

cont

amin

atio

n.Fr

eque

ntle

aks,

rust

-col

ored

wat

er,

and

stai

nson

fixtu

res,

dish

es,

and

laun

dry

are

sign

sof

ccrr

cve

wae

rB

lue-

gree

nde

posi

tson

pipe

san

dsi

nks

indi

cate

copp

erco

rros

ion;

brow

nst

ains

resu

ltfro

mm

eco

rros

ion

Firo

n,W

here

such

sign

soc

cur,

high

leve

lsof

lead

,co

pper

,an

diro

nm

aybe

pres

ent

intfl

ew

ater

.Le

adca

accu

mul

ate

with

iron,

whi

chca

nfo

rmse

dim

ents

that

are

hard

tore

mov

e,Pe

rman

ently

out o

f ser

vice

wat

erou

tlets

are

outle

tsth

atar

eno

long

erbe

ing

used

and

the

facy

pns

tode

com

mis

sion

inth

efu

ture

.

Tem

pora

rily

outo

f ser

vice

wat

erou

tlets

are

outle

tsth

atre

quire

repa

iror

repl

acem

ent

and

wiH

bepu

tba

ckin

serv

ice

once

they

are

oper

atio

nal.

iiV

ersi

on1.1

July

21,

2016

(NJD

EP)

Attachment CDrinking Water Outlet

Inventory

Nam

eof

Sch

ool:

HO

LD

RU

MR

IVE

RV

AL

EN

J07

675

Att

achm

ent

C-

Dri

nkin

gW

ater

Outl

etIn

ven

tory

(Cor

npl

ete

for

each

scho

ol)

___________________________________

Add

ress

:_3

93R

IVE

RV

AL

ER

D

0

Gra

de

Lev

els:

6-8

_____

Yea

rS

choo

lC

onst

ruct

ed:1

953

_196

6,20

01R

enov

ated

/Add

itio

ns:

Indi

vidu

alsc

hool

proj

ect

offi

cer

Nam

e/S

igna

ture

:D

ate

Com

plet

ed:

j’

Typ

eL

ocat

ion

Cod

eO

pera

tion

al2

Sign

sof

Fil

ter

4B

rass

Aer

ator

!M

otio

nC

hill

erW

ater

Coo

ler

Com

men

ts(Y

/N)

Cor

rosi

on(Y

/N)

Fitti

ngs,

Scre

enA

ctiv

ated

(Y/N

)M

ake

Mod

e)SE

RIA

LFa

ucet

s(Y

/N)

(YIN

)(Y

IN)

or valv

es?

(YIN

)1

WA

TE

RH

ALL

WA

YH

-HW

-93-

YE

SN

OY

ES

YE

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ES

EL

KA

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S8I

0304

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CO

OL

ER

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LW

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3-Y

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NO

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ER

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‘Num

ber

outle

tsst

artin

gat

the

clos

est

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tto

the

Poin

tof

Ent

ry(P

OE

).2

Doc

umen

tif

perm

anen

tly

orte

mpo

rari

lyou

tof

serv

ice

onth

eA

ttach

men

tB

-Pl

umbi

ngPr

ofile

.Si

gns

ofco

rros

ion

dete

cted

,su

chas

but

not

limite

dto

freq

uent

leak

s,ru

st-c

olor

edw

ater

,or

stai

ned

fixt

ures

,di

shes

,or

laun

dry.

Doc

umen

ton

Att

achm

ent

D-

Filte

rIn

vent

ory.

1V

ersi

on1.

1Ju

ly21

,20

16(N

JDEP

)

0LU

(D

cDc’.J

(N>

0U)

>

Attachment DFilter Inventory

C-,

C C d CD C-, 0 C-,

ct C,)

Cc -J

•)

—

(0.

-

C13

0,

0 C—

0 (-xl

0)

C 0 m -o

—S

i- C-

,

Z

c.1,

ID CD0 0 -

ID-ç —

rc; h 3:c Sc hocr1s ) Snnpiir Ian

ALtidirnent D — Filter !

Cocvptc1i eaic;h scot)

0L3

V’e SL(L)f’ 0

r’aine• c:yt Schoot HOL DRfJM6-8

Adress.: 93 RvivaIe d Rivevae NJ07675

Grade LeveFs:

Individual School Project Officer Signature: Date:

Sample Location I Ri andCode

Type 1 Dale [eplacemenl(Make & Installed FrequencyModel) or

Replaced

WATERSENTRYviii

NSFCertitiedfor LeadReduction

YIN

YES

H-CL-63-S NO NOFILTER FILTER

H-HW-56.-WC ELKAY WATER YESSENTRYviii

H-N-50-SINK ELKAY WATER YESSENTRYviii

H-HVV-14-WC ELKAY WATER t YESSENTRY

H-HW93-WC- 1 ELKAY

H-H/V-9S-WG-2 E LKAY WATER YESSENTRYviii


(River v&v PuNk Schools ) S.arnpimnr PbnDit u

\/ersion 0H-FRi2-SNK


Attachment EFlushing Log

Name of School:Holdrum_________________

Address: 393 Rivervale road

Grade Levels: 6-8

Attachment E Flushmg Log(Complete for each school as applicable)

Individual School Project Officer Signature:

SampleLocation

CodeH-HW-93-

WC-1

Date:

Rivervale Public Schools Sampling PlanDate

Version 0

Reason forFlushing

Sample LocationDescription

Date

WATER COOLERHALLWAY#93

Time Duration ofFlushing

WATER COOLER H-HW-93-HALLWAY#93 WC-2

SINK H-CL-63-SMUSIC ROOM

#50WATER COOLER H-HW-56-

HALLWAY#56 WCSINK H-N-50-

NURSES OFFICE SINK#50

KITCHEN SINK H-KC-54-SROOM#54

WATER COOLER / H-HW-14-HALLWAY#14 WC

SINK H-FR-12-FACULTY ROOM SINK

#12


Rivervale Ptiblic Schools Sampling PlanDate

Version 0

/

/

/

‘F


Attachment FPre-Sampling Water

Use Certification

(INSERT SCHOOL DISTRICT NAME) Sampling Plan

Attachment F - Pre - Sampling Water Use Certification(Complete for each school)

DateVersion 0

Sicinature

Time: Date:

Time: Date:

Date

TO BE COMPLETED BY THE <<SCHOOL NAME>> DISTRICT REPRESENTATIVE:

School Name:

_____________

Sample collection address:

_____________________________________________________

Water was last used:

_____________________________________________________

Sample commencement:

___________________________________________________

I have read the (INSER’I’ S(’IIOOL DIS’i’RIU’I’ A1F) Lead Drinking Water TestingSampling Plan and Quality Assurance Project Plan and I am certifying that samples werecollected in accordance with these plans.


Attachment GExample of a Sample

Flush Tag

Attachment G - Example of a Sample Flush Tag

FLUSH TAG

Water outlet sampling in progress. Please do not use water

School District Name: — INSERT SUHOOL I)ISTRR’T NAMI) Date Flushed:

School Name: Flushing ProcessSchool Address: Start Time:Location of flushed outlet: End Time:

Is the fountain front cover removed for the sampler to determine the reservoir type (circle one):YES/NO

Person responsible for the flushing process (print name):

____________________________________

Signature:

* Water within the school distribution system should sit in the pipes unused for at least eight (8)hours after flushing hut not more than 48 hours before a sample is taken.*

Note to the person responsible for the flushing process:A. Turn-off lawn sprinkler outlet(s) until water sampling is complete.B. Make sure sampling outlets are accessible.


Roberge Annex

Attachment A - List of (Rivervale Public SchoolsPnority for Sampling

DATE OF CERTIFIED NOTESSAMPLING LABORATORY

1ST FOUNTAIN ACROSS FROM ROOM fi305 (2 FLOOR)

2ND FOUNT1JN ACROSS FROM ROOM #209 (1ST FLOOR)

3RD FOUNTAIN ACROSS FROM ROOM #302 (2 FLOOR)

SCHOOL NAME Roberge Annex

Version 1.1 July 15, 2016 (NJDP)

Attachment A - List of (Rivervale Public SchoolsPrionty for Sampling

SCHOOL NAME Roberge Annex

1iT FOUNTAIN ACROSS FROM ROOM 1t305 (2 FLOOR)

—________ I

DATE OFSAMPLING

CERTIFI EDLABORATORY

NOTES

2ND FOUNTAIN ACROSS FROM ROOM U209 (JST FLOOR)

3 FOUNTAIN ACROSS FROM ROOM U302 (2FLOOR)



Att

achm

ent

B-

Plu

mbin

gP

rofi

leNo

te.’

Com

plet

efo

rea

chsc

hool

.F

orad

diti

onal

info

rmat

ion

see

the

US

EP

Apu

blic

atio

n,“T

he3T

sfo

rR

educ

ing

Lea

din

Dri

nkin

gW

ater

inS

choo

lsN

ame

ofS

choo

l:R

OB

ER

GE

AN

NE

X__

____

____

____

____

____

____

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rade

Lev

els:

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MIN

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Add

ress

:6O

9WE

STW

OO

DA

VE

___________________________________

Indi

vidu

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proj

ect

offi

cer

Sig

natu

re:

____

____

____

____

____

____

____

_

Dat

e:

Que

stio

nsfA

sw

ers

Bac

kgro

und

Info

rmat

ion

1.W

hat

year

was

the

orig

inal

build

ing

cons

truc

ted?

1 908

Wer

ean

ybu

ildi

ngs

orad

diti

ons

adde

dto

the

orig

inal

AD

DIT

ION

1936

facU

ity?

2.If

the

buH

ding

was

cons

truc

ted

orre

pair

edaf

ter

1986

,Y

ES

was

lead

-fre

epl

umbi

ngan

dso

lder

util

ized

?IW

hat

type

ofso

lder

was

used

?D

ocum

ent

all

cati

ons

whe

rele

adso

lder

was

used

.T

HR

UO

UT

3.W

here

are

the

mos

tre

cent

plum

bing

repa

irs

and

Loc

atio

n:2N

DFL

OO

RD

escr

ipti

on:

RE

ST

RO

OM

Sre

plac

emen

ts?

4.W

ithw

hat

mat

eria

lsis

the

serv

ice

conn

ecti

on(t

hepi

peM

ater

ial:

CO

OP

ER

that

carr

ies

wat

erto

the

scho

olfr

omth

epu

blic

wat

ersy

stem

’sm

ain

inth

est

reet

)m

ade?

Loc

atio

n:L

OW

ER

LE

VE

LR

OO

M#2

12W

here

isth

eS

ervi

ceL

ine

loca

ted?

(Thi

sis

the

PO

Elo

cati

on.)

.Is

ther

epo

int

ofen

try

(PO

E)

orpo

int

ofus

e(P

OU

)N

Otr

eatm

ent

inuse

?T

ype:

Loc

atio

n:

Ver

sion

1.1

JUly

21,

2016

(NU

DEP

)

IS

—

Ans_____________________

6.A

reth

ere

tanks

inyo

urpl

umbi

ngsy

stem

(pre

ssur

eta

nks,

NO

grav

ity

stor

age

tank

s)?

7.D

oes

the

scho

olha

vea

filte

rm

aint

enan

cean

dop

erat

ion

YE

Spr

ogra

m?

DIR

EC

TO

RO

FB

UIL

DIN

GS

AN

DG

RO

UN

DS

Ifso

,w

hois

resp

onsi

ble

for

this

prog

ram

?W

hat

isth

epr

oces

sfo

rad

ding

filt

ers?

FIL

TE

RS

AD

DE

DA

SN

EE

DE

DB

ASE

DO

NT

ES

TR

ES

UL

TS

8.H

ave

acce

ssib

lesc

reen

sor

aera

tors

onou

tlet

sth

atY

/N

prov

ide

drin

king

wat

erbe

encl

eane

d?D

oes

the

scho

olha

vea

scre

enor

aera

tor

mai

nten

ance

prog

ram

?9.

Hav

eth

ere

been

any

com

plai

nts

abou

tba

d(m

etal

lic)

NO

tast

e?N

ote

loca

tion

(s).

Loc

atio

n:10

.R

evie

wre

cord

san

dco

nsul

tw

ithth

epu

blic

wat

ersu

ppli

erto

dete

rmin

ew

heth

eran

yw

ater

sam

ples

have

been

take

nin

the

build

ing

for

any

cont

amin

ants

.If

so,

iden

tify:

•N

ame

ofco

ntam

inan

t(s)

•C

once

ntra

tion

sfo

und

•pH

leve

lIs

test

ing

done

regu

larl

yat

the

buil

ding

?Y

ES

11.

Oth

erpl

umbi

ngba

ckgr

ound

ques

tion

sin

clud

e:.

Are

blue

prin

tsof

the

build

ing

avai

labl

e?N

O•

Are

ther

ekn

own

plum

bing

“dea

d-en

ds”,

low

use

area

s,ex

isti

ngle

aks

orot

her

“pro

blem

area

s”?

Are

reno

vati

ons

plan

ned

for

any

ofth

epl

umbi

ngsy

stem

?

2V

ersi

on1.

1Ju

iy21

.20

16(N

JDEP

)

Que

stio

ns—

Answ

ers

Wal

k-T

hro

ugh

The

sequ

esti

ons

shou

ldbe

c:r

ess

eo

duri

ngth

ew

alk-

thro

ugh

ofth

efa

cilit

y,w

hile

Att

achm

ent

C-

Dri

nkin

gW

ater

Out

let

Inve

ntor

yis

bein

gco

mpl

eted

.

i1.

Con

firm

the

mat

eria

lof

Ser

vice

Lin

evi

sual

ly.

CO

OP

ER

2.C

onfi

rmth

ep

rese

nce

ofP

OE

orPO

Utr

eatm

ent.

NO

NE

3.W

hat

are

the

pota

ble

wat

erpi

pes

mad

eof

inyo

urfa

cilit

y?a

Lea

da

Pla

stic

.G

alva

nize

dM

etal

aC

ast

Iron

aC

oppe

ra

Oth

erN

ote

the

wat

erfl

owth

roug

hth

ebu

ildin

gan

dth

ear

eas

that

rece

ive

wat

erfi

rst,

and

whi

char

eas

rece

ive

wat

erla

st.

4.A

reel

ectr

ical

wir

esgr

ound

edto

Wat

erP

ipes

?Y

ES

Not

elo

cati

on(s

).L

ocat

ion:

5.A

rebra

ssfi

tting

s,fa

ucet

s,or

valv

esus

edin

your

drin

king

Com

plet

ein

“Bra

ss”

Col

umn

inA

ttac

hmen

tC

-W

ater

Out

let

Inve

ntor

y.w

ater

syst

em?

Not

eth

atm

ost

fauc

ets

are

bras

son

the

insi

de.

Doc

umen

tth

elo

cati

ons

ofan

yb

rass

wat

erou

tlet

tobe

sam

pled

.6.

Loc

ate

all

drin

king

wat

erou

tlet

s(i

.e.

wat

erco

oler

s,C

ompl

ete

inA

ttac

hmen

tC

-Wat

erO

utle

tIn

vent

ory.

bubb

lers

,ic

em

achi

nes,

kitc

hen!

food

prep

sink

s,et

c.)

inth

efa

cilit

y.7.

Hav

eth

ebr

ands

and

mod

els

ofth

ew

ater

cool

ers

inth

eY

/N

scho

olbe

enco

mpa

red

toth

elis

tof

reca

lled

wat

erco

oler

sin

the

Too

lkit?

Rec

alle

dD

rink

ing

Wat

erF

ount

ains

Mak

ean

dM

odel

Typ

e

Ver

sion

1.1Ju

ij21

.20

16(N

JDEP

)

[Ques

tions

—A

nsw

ers

8.H

ave

signs

ofco

rros

ion,

such

asfr

eque

ntle

aks,

rust

-C

ompl

ete

in“S

igns

ofC

orro

sion

”co

lum

nin

Att

achm

ent

C-

Dri

nkin

gco

lore

dw

ater

,or

stai

ned

fixt

ures

,dis

hes

,or

laun

dry

bee

nW

ater

Out

let

Inve

ntor

y.det

ecte

d?

Not

eth

ekca

tions

ofw

ater

outl

ets.

9.A

reth

ere

any

outl

ets

that

are

not

oper

atio

nal

and

YI

Nth

eref

ore

out

ofse

rvic

e?P

erm

anen

tly?

Tem

pora

rily

?C

ompl

ete

“Ope

rati

onal

Col

umn”

inA

ttac

hmen

tC

Dri

nkin

gW

ater

Out

let

Inve

ntor

y.

Typ

e!L

ocat

ion

Des

crip

tion

Per

man

entl

y

[T

empo

rari

ly

4\/e

rsio

n1.1

21,

2016

(NJD

EP)

Att

achm

ent

B.i:

Plu

mbin

gP

rofi

leIn

stru

ctio

ns

Plum

bing

Prof

ileQ

uest

ions

Wha

tYou

rAns

wer

sto

the

Plum

bing

Prof

ileQ

uest

ions

Mea

nTh

equ

estio

nsin

this

colu

mn

will

help

you

This

colu

mn

disc

usse

sth

esi

gnifi

canc

eof

poss

ible

answ

ers

toth

epl

umbi

ngpr

ofile

ques

tions

.de

term

ine

whe

ther

lead

islik

ely

tobe

apr

oble

min

your

faci

lity,

and

will

enab

leyo

uto

prio

ritiz

eyo

ursa

mpl

ing

effo

rt.

Bac

kgro

und

Info

rmat

ion

1,W

hen

was

the

orig

inal

build

ing

cons

truct

ed?

Old

erB

uild

ings

—Th

roug

hth

eea

rly1 9

00s,

lead

pipe

sw

ere

com

mon

lyus

edfo

rin

terio

rpl

umbi

ngin

certa

inpa

rtsof

the

coun

tryin

publ

icbu

ildin

gsan

dpr

ivat

eho

mes

.Pl

umbi

ngin

stalle

dbe

fore

1930

ism

ore

Wer

ean

ybu

ildin

gsor

addi

tions

adde

dto

the

orig

inal

likely

toco

ntai

nle

adth

anne

wer

pipe

s.Be

twee

n19

20an

d19

50,g

alva

nize

dpi

pes

wer

eal

sous

edfo

rfa

cility

?If

so, c

ompl

ete

ase

para

tepl

umbi

ngpr

ofile

plum

bing

.Af

ter19

30,c

oppe

r gen

eral

lyre

plac

edle

adas

the

mos

tcom

mon

lyus

edm

ater

ial f

orw

ater

for e

ach

build

ing,

addi

tion,

orw

ing.

pipe

s.U

pun

tilth

em

id- t

ola

te-i

980s

(unt

ilth

ele

ad-f

ree

requ

irem

ents

ofth

e19

86Sa

feD

rinki

ngW

ater

Act

Am

endm

ents

took

effe

ct),

lead

sold

erw

asty

pica

llyus

edto

join

thes

eco

pper

pipe

s.Th

eef

forts

ofyo

urpu

blic

wat

ersu

pplie

rove

rth

eye

ars

tom

inim

ize

the

corr

o&ve

ness

ofth

ew

ater

may

have

resu

lted

inm

iner

alde

posi

tsfo

rmin

ga

coat

ing

onth

ein

side

ofth

ew

ater

pipe

s(p

assi

vatio

n).T

his

coat

ing

insu

late

sth

ew

ater

from

the

plum

bing

and

resu

ltsin

decr

ease

dle

adle

vels

inw

ater

,If

the

coat

ing

does

not e

xist

oris

dist

urbe

d,th

ew

ater

isin

dire

ctco

ntac

twith

any

lead

inth

epl

umbi

ngsy

stem

.

New

erB

uild

ings

—N

ewbu

ildin

gsar

eno

t lik

elyto

have

lead

pipe

sin

thei

rpl

umbi

ngsy

stem

s,bu

t the

yar

eve

rylik

ely

toha

veco

pper

pipe

swi

thso

lder

join

ts.

Bui

ldin

gsco

nstr

ucte

dpr

iort

oth

ela

teI 9

80s,

befo

reth

ele

ad-f

ree

requ

irem

ents

ofth

e19

86Sa

feD

rinki

ngW

ater

Act

Am

endm

ents

,m

ayha

vejo

ints

mad

eof

lead

sold

er.

Bui

ldin

gsco

nstru

cted

afte

rthi

spe

riod

shou

ldha

vejo

Hts

mad

eof

lead

-fre

eso

lder

s,Ev

enif

“lea

d-fr

ee”

mat

eria

lsw

ere

used

inne

wco

nstru

ctio

nan

d/or

plum

bing

repa

irsle

ad

__________

leac

hing

may

occu

r.

5V

ersi

on1.1

July

21,

2016

(NJD

EP)

Plum

bing

Prof

ileQ

uest

ions

2.if

built

orre

paire

daf

ter

1986

,wer

ele

ad-f

ree

plum

bing

and

sold

erus

edin

acco

rdan

cew

ithth

ele

ad-f

ree

requ

irem

ents

ofth

e19

86Sa

feD

rinki

ngW

ater

Act

Am

endm

ents

?W

hatt

ype

ofso

lder

has

been

used

?

Was

lead

sold

erus

edin

your

plum

bing

syst

em?

Not

eth

elo

catio

nsof

lead

sold

er.

3.W

hen

wer

eth

em

ostr

ecen

tpl

umbi

ngre

pairs

and

repl

acem

ents

mad

e(n

ote

loca

tions

)?

4.W

ithw

hat

mat

eria

lsis

the

serv

ice

conn

ectio

n(th

epi

peth

atca

rrie

sw

ater

toth

esc

hool

from

the

publ

icw

ater

syst

ems

mai

nin

the

stre

et)

mad

e?N

ote

the

loca

tion

whe

reth

ese

rvic

eco

nnec

tion

ente

rsth

ebu

ildin

gan

dco

nnec

tsto

the

inte

rior

plum

bing

.(T

his

isth

ePO

Elo

catio

n)

Wha

tYou

rA

nsw

ers

toth

ePl

umbi

ngPr

ofile

Que

stio

nsM

ean

P

The

1986

Am

endm

ents

toth

eSa

feD

rinki

ngW

ater

Act

bann

edpl

umbi

ngco

mpo

nent

sth

atco

ntai

ned

elev

ated

leve

lsof

lead

.Le

ad-f

ree

sold

eran

dflu

x(n

otm

ore

than

0.2%

lead

)an

dpi

pe,

pipe

fittin

gs,

and

fixtu

res

(not

mor

eth

an8%

lead

)m

ust

now

beus

ed.

The

leac

hing

pote

nUal

ofle

ad-f

ree

(i.e.

tin-

antim

ony)

sold

eris

muc

hle

ssth

anle

adso

lder

.Th

ele

achi

ngpo

tent

ial

ofle

ad-f

ree

pipe

, pip

eu

ng

s,an

dfix

ture

sis

also

less

,bu

tlea

chin

gis

still

poss

ible

.

Ifle

ad-f

ree

mat

eria

lsw

ere

notu

sed

inne

wco

nstru

ctio

nan

d/or

plum

bing

repa

irs,

elev

ated

lead

leve

lsca

nbe

prod

uced

.If

the

film

resu

lting

from

pass

ivat

ion

does

note

xist

orha

sno

t yet

adeq

uate

lyfo

rmed

,an

yle

adth

atis

pres

enti

sin

dire

ctco

ntac

twith

the

wat

er.

Inso

me

area

sof

the

coun

try,

itis

poss

ible

that

high

-lead

mat

eria

lsw

ere

used

until

1988

orpe

rhap

sev

enla

ter,

You

rlo

cal

plum

bing

code

auth

ority

orbu

ildin

gin

spec

tor

may

beab

leto

prov

ide

guid

ance

rega

rdin

gw

hen

high

-lead

mat

eria

lsw

ere

last

used

ona

regu

lar

basi

sin

your

area

.C

orro

sion

occu

rs(1

)as

are

actio

nbe

twee

nth

ew

ater

and

the

pipe

san

d(2

)as

are

actio

nbe

tvee

nth

eco

pper

and

sold

er(m

etal

-to-m

etal

).Th

isla

tter

reac

tion

iskn

own

asga

lvan

icco

rros

ion,

whi

chca

nbe

vigo

rous

inne

wpi

ping

.If

lead

sold

ers

wer

eus

edin

the

pipi

ngor

ifbr

ass

fauc

ets,

valv

es,

and

fittn

gsco

ntai

ning

allo

ysof

lead

wer

ein

stal

led

(see

resp

onse

toW

alk

Thro

ugh

Que

stio

n5

belo

wfo

rfur

ther

disc

ussi

onof

bras

s),

lead

leve

lsin

the

wat

erm

aybe

high

.A

fter

abou

t5

year

s,ho

wev

er,

this

tjpe

ofre

actio

n(g

alva

nic

corr

osio

n)sl

ows

dow

nan

dle

adge

tsin

tow

ater

mai

nly

asa

resu

ltof

wat

erbe

ing

corr

osiv

e.If

the

wat

eris

non-

corr

osiv

e,pa

ssiv

atio

nis

likely

toha

veoc

curr

edan

dto

have

redu

ced

oppo

rtuni

ties

forl

ead

toge

tint

oth

ew

ater

syst

em.

For t

hese

reas

ons,

ifth

ebu

ildin

g(o

ran

addi

tion,

new

plum

bing

, or

repa

ir)is

less

than

5ye

ars

cdan

dle

adso

lder

orot

her

mat

eria

ls(e

.g.,

bras

sfa

ucet

sco

ntai

ning

lead

allo

ys)

wer

eus

ed,

you

may

have

elev

ated

lead

leve

ls.

Ifw

ater

supp

lied

toth

ebu

ildin

gis

corr

osiv

e,le

adca

nre

mai

na

prob

lem

rega

rdle

ssof

the

plum

bing

’sag

e.

Lead

pipi

ngw

asof

ten

used

for

the

serv

ice

conn

ectio

nsth

atjo

inbu

ildin

gsto

publ

icw

ater

syst

ems.

The

serv

ice

conn

ectio

nis

the

pipe

that

carr

ies

drin

king

wat

erfro

ma

publ

icw

ater

mai

nto

abu

ildin

g.So

me

loca

litie

sac

tual

lyre

quire

dth

eus

eof

lead

serv

ice

conn

ectio

nsup

until

the

lead

-fre

ere

quire

men

tsof

the

1986

Safe

Drin

king

Wat

erA

ctA

men

dmen

tsto

okef

fect

,A

lthou

gha

prot

ectiv

ela

yerin

gof

min

eral

sm

ayha

vefo

rmed

onth

ese

pipe

s,vi

brat

ions

can

caus

efla

king

ofan

ypr

otec

tive

build

-up

and,

slow

ing

lead

cont

amin

atio

nto

occu

r.

6V

ersi

on1.1

July

21,

2016

(NJD

EP)

Plum

bing

Prof

ileQ

uest

ions

Wha

t You

rA

nsw

ers

toth

ePl

umbi

ngPr

ofile

Que

stio

nsM

ean

5.l

ther

epo

int o

f ent

ry(P

OE)

orpo

int o

f use

(PO

U)

Are

ther

ew

ater

trea

tmen

t uni

tsin

your

plum

bing

syst

em?

Tre

atm

ent u

nits

coul

dbe

,bu

tare

not

limite

dto

,tr

eatm

ent i

nus

e?io

nex

chan

geun

its, f

ilter

cartr

idge

,re

serv

eos

mos

is,

etc.

6.D

oyo

uha

veta

nks

inyo

urpl

umbi

ngsy

stem

Som

eol

der

tank

sm

ayco

ntai

nco

atin

gsth

atar

ehi

ghin

lead

cont

ent.

(pre

ssur

eta

nks,

grav

ityst

orag

eta

nks)

?Ta

nks

may

accu

mul

ate

sedi

men

t tha

tcou

ldbe

flush

edba

ckin

toth

epu

mbh

gsy

stem

unde

rce

rtain

Not

eth

elo

catio

nof

any

tank

s,an

dan

yav

aila

ble

circ

umst

ance

s.Y

oum

ayw

ishto

cont

act t

hesu

pplie

ror

man

ufac

ture

rto

obta

inin

form

atio

nab

outc

oahn

gs.

info

rmat

ion

abou

t the

tank

;e.

g.,

man

ufac

ture

r,da

teof

You

may

also

wish

tohi

rea

plum

ber

orta

nkse

rvic

eco

ntra

ctor

toin

spec

t you

rta

nks,

espe

cia’

]gra

iyin

stal

latio

n,st

orag

eta

nks

that

are

loca

ted

outs

ide

ofth

ebu

ildin

g.7.

Doe

sth

esc

hool

have

afil

ter

mai

nten

ance

and

Apr

ogra

mfo

r the

mai

nten

ance

and

the

upke

epof

filte

rson

drin

king

wat

erou

tlets

isne

cess

ary

toen

sure

the

oper

atio

npr

ogra

m?

effe

ctiv

enes

sof

the

filte

rs.

Mos

tfilt

ers

reco

mm

end

repl

acem

ent

afte

rsix

mon

ths.

Ifth

efil

ters

need

Ifso

,w

hois

resp

onsi

ble

for t

his

prog

ram

?re

plac

emen

t eve

rysix

mon

ths,

the

prog

ram

will

incl

ude

apr

oced

ure

fore

nsur

ing

that

ever

ysix

mon

thol

dW

hati

sth

epr

oces

sfo

rad

ding

filte

rs?

filte

ris

repl

aced

. An

indi

vidu

alsh

ould

bere

spon

sibl

efo

r ens

urin

gth

atth

isfi

erm

aint

enan

cepr

ogra

mis

follo

wed

,

Ifth

esc

hool

wou

ldlik

eto

add

afil

ter t

oa

wat

erou

tlet,

wha

t is

the

proc

ess?

Doe

sa

requ

est

form

have

tobe

com

plet

edan

dsu

bmitt

edto

the

indi

vidu

alin

char

geof

mai

nten

ance

?Do

allfil

ters

need

tobe

adde

dat

ace

rtain

time

ofye

arto

follo

wth

em

aint

enan

cepr

ogra

m?

8.D

oou

tlets

that

prov

ide

drin

king

wat

erha

veLe

ad-c

onta

inin

gse

dim

ents

that

are

trap

ped

onsc

reen

sca

nbe

asi

gnifi

cant

sour

ceof

lead

cont

amin

aon,

acce

ssib

lesc

reen

sor

aera

tors

?(S

tand

ard

fauc

ets

Sedi

men

tssh

ould

bete

sted

for t

hepr

esen

ceof

lead

,an

dyo

urfa

cilit

ysh

ould

crea

tea

rout

ine

mai

nten

ance

usua

ilyha

vesc

reen

s.M

any

cool

ers

and

bubb

lers

prog

ram

tocl

ean

the

scre

ens

freq

uent

ly.

Ifse

dim

ent h

asbe

ena

reoc

curr

ing

prob

lem

regu

lar

clea

ning

ofal

soha

vesc

reen

s.)

Not

eth

elo

catio

ns,

the

scre

ens

and

addi

tiona

lin

vest

igat

ing

into

why

the

debr

isis

accu

mul

atin

gis

appr

opria

te.

How

ever

,th

em

anuf

actu

rer

orw

ater

serv

ice

prov

ider

shou

ldbe

cont

acte

dto

obta

inin

stru

ctio

ns.

Hav

eth

ese

scre

ens

been

clea

ned?

Not

eth

elo

catio

ns.

9.H

ave

ther

ebe

enan

yco

mpl

aint

sab

out w

ater

tast

eA

lthou

ghyo

uca

nnot

see,

tast

e,or

smel

lle

addi

ssol

ved

inw

ater

,th

epr

esen

ceof

am

etaB

icta

ste

orru

sty

(met

allic

,et

c.)

orru

sty

appe

aran

ce?

Not

eth

eap

pear

ance

may

indi

cate

corr

osio

nan

dpo

ssib

lele

adco

ntam

inat

ion.

loca

tions

.

7V

ersi

on‘1.

1Ju

ly21

,20

16(N

JDEP

)

Plum

bing

Prof

ileQ

uest

ions

Wha

tYou

rA

nsw

ers

toth

ePl

umbi

ngPr

ofile

Que

stio

nsM

ean

10.

Che

ckbu

ildin

gfil

esto

dete

rmin

ew

heth

eran

yLe

adte

stin

gm

ayha

vepr

evio

usly

been

done

volu

ntar

ilyun

der

the

Lead

Con

tarn

inaU

onC

ontro

lAc

t.w

ater

sam

ples

have

been

take

nfro

myo

urbu

ildin

gfo

rR

esul

tsof

anal

yses

ofge

nera

lw

ater

qual

ity,

such

asm

easu

res

ofpH

.ca

lciu

mha

rdne

ss,

and

carb

onat

ean

yco

ntam

inan

ts(a

lso

chec

kw

ithyo

urpu

blic

wat

eral

kalin

ity,c

anpr

ovid

eim

porta

ntcl

ues

abou

tthe

corr

osiv

enes

sof

the

wat

er.

Gen

erat

y,th

ehi

gher

the

supp

lier)

,va

lues

ofth

ese

para

met

ers,

the

less

likel

yit

isth

atyo

urw

ater

isco

rros

ive,

Ifyo

uha

veno

data

from

your

scho

ol,

your

publ

icw

ater

syst

emsh

ould

atle

ast b

eab

leto

prov

ide

info

rmat

ion

abou

tthe

gene

ral

wat

erN

ame

ofco

ntam

inan

t(s)

?qu

ality

..

Wha

tcon

cent

ratio

nsof

thes

eco

ntam

inan

tsw

ere

foun

d?.

Wha

twas

the

pHle

velo

f the

wat

er?

.Is

_tes

ting_

done

_reg

ular

ly_a

t_yo

ur_f

acili

ty?

11.

Oth

erpl

umbi

ngqu

estio

ns;

You

shou

ldin

corp

orat

eth

isin

form

atio

nin

tode

cisi

ons

rega

rdin

gsa

mpl

elo

catio

nsan

dsa

mpn

gpr

otoc

ol.

You

may

wish

tono

teth

edi

rect

ion

ofw

ater

flow

and

the

loca

tion

offix

ture

s,va

lves

,ta

nks,

area

sof

sedi

men

tA

rebl

uepr

ints

ofth

ebu

ildin

gav

aila

ble?

accu

mul

atio

n,ar

eas

ofco

rros

ion,

etc.

,on

ask

etch

orbl

uepr

into

fthe

plum

bing

..

Are

ther

ekn

own

plum

bing

“dea

den

ds,”

law

use

area

s,ex

istin

gle

aks

orot

her

“pro

blem

area

s”?

.A

rere

nova

tions

bein

gpl

anne

dfo

rpa

rtor

allof

the_

plum

bing

_sys

tem

?W

alk.

Thro

ugh

1.C

onfir

mth

em

ater

ialt

hat t

hese

rvic

elin

eis

See

Bac

kgro

und

Info

rmat

ion

Que

stio

n#4

.m

ade

ofvi

sual

ly

2.Co

nfirm

the

pres

ence

ofPO

Eor

POU

See

Bac

kgro

und

Info

rmat

ion

Que

stio

n#5

treat

men

t.

8V

ersi

on1.1

July

21,

2016

(NJD

EP)

Surv

eyyo

urbu

ildin

gfo

r exp

osed

pipe

s,pr

efer

ably

acco

mpa

nied

byan

expe

rien

ced

plum

ber w

hosh

ould

beab

leto

read

ilyid

entif

yth

eco

mpo

sitio

nof

pipe

son

site

.M

ost b

uild

ings

have

aco

mbi

natio

nof

diff

eren

tpl

umbi

ngm

ater

ials

:

•Le

adpi

pes

are

dull

gray

inco

lor

and

may

beea

sily

scra

tche

dby

anob

ject

such

asa

knfe

orke

y.Le

adpi

pes

are

am

ajor

sour

ceof

lead

cont

amin

atio

nin

drin

king

wat

er.

•G

alva

nize

dm

etal

pipe

sar

egr

ayor

silv

er-g

ray

inco

lor

and

are

usua

yfit

ted

toge

ther

with

thre

aded

join

ts.

Inso

me

inst

ance

s,co

mpo

unds

cont

aini

ngle

adha

vebe

enus

edto

seal

the

thre

ads

Join

ing

the

pipe

s.D

ebris

from

this

mat

eria

l,w

hich

has

falle

nin

side

the

pipe

s,m

aybe

aso

urce

ofco

ntam

inat

ion.

•C

oppe

rpi

pes

are

red-

brow

nin

colo

r.C

orro

ded

porti

ons

may

show

gree

nde

posi

ts.

Cop

per

ppe

join

tsw

ere

typi

cally

join

edto

geth

erwi

thle

adso

lder

sun

tilth

ele

ad-f

ree

requ

irem

ents

ofth

e19

86Sa

feD

rinki

ngW

ater

Act

Am

endm

ents

took

effe

ct.

•Pl

astic

pipe

s,es

peci

ally

thos

em

anuf

actu

red

abro

ad,

may

cont

ain

lead

.if

p!as

ticpi

pes

are

used

,be

sure

they

mee

t NSF

Inte

rnat

iona

l sta

ndar

ds.

(Not

e:N

SFIn

tern

atio

nal i

san

inde

pend

ent,

third

-pa

rty

test

ing

orga

niza

tion.

Prod

uct l

istin

gsca

nbe

obta

ined

byvi

sitin

gth

eir

Web

site

atht

t,o://

ww

w. n

sf.o

rq/ b

usin

ess/

sear

chIis

tinqs

/inde

x/as

p.)

4.Is

any

elec

trica

l equ

ipm

ent g

roun

ded

tow

ater

Ifel

ectri

cal e

quip

men

t,su

chas

tele

phon

es,

has

been

inst

alle

dus

ing

wat

erpi

pes

asa

grou

nd,

the

elec

tric

pipe

s?N

ote

the

loca

tions

,cu

rren

t tra

velin

gth

roug

hth

egr

ound

wire

will

acce

lera

teth

eco

rros

ion

ofan

yin

terio

r plu

mbi

ngco

ntai

ning

lead

,Th

epr

actic

esh

ould

beav

oide

d,if

poss

ible

.H

owev

er,

ifex

istin

gw

ires

are

&re

ady

grou

nded

tow

ater

pipe

s,th

ew

ires

shou

ldno

t be

rem

oved

from

the

pipe

sun

less

aqu

alifi

edel

ectri

cian

inst

alls

anal

tern

ativ

egr

ound

ing

syst

em.

Che

ckw

ithyo

urlo

cal

build

ing

insp

ecto

r on

this

mat

ter,

You

rst

ate

orlo

cal

budi

ngco

dem

ayre

quire

grou

ndin

gof

the

wire

sto

the

wat

erpi

pes.

Impr

oper

grou

ndin

gof

elec

trica

leq

uipm

ent

may

caus

ese

vere

shoc

k.

Plum

bing

Prof

ileQ

uest

ions

Wha

t You

r Ans

wer

sto

the

Plum

bing

Prof

ileQ

uest

ions

Mea

n3.

Spec

ifica

lly, w

hat a

reth

epo

tabl

ew

ater

pipe

sm

ade

ofin

your

faci

lity

(not

eth

elo

catio

ns)?

•Le

ad•

Plas

tic•

Gal

vani

zed

Met

al•

Cas

tIro

n•

Cop

per

•O

ther

Not

eth

elo

catio

nof

the

diff

eren

t typ

esof

pipe

,if

appl

icab

le,

and

the

dire

ctio

nof

wat

erflo

wth

roug

hth

ebu

ildin

g.N

ote

the

area

sof

the

build

ing

that

rece

ive

wat

erfir

st,an

dw

hich

area

sre

ceiv

ew

ater

last

.

•1

9V

ersi

on1.

1Ju

21,

2016

(NJD

EP)

Wha

tYou

r Ans

wer

sto

the

Plum

bing

Prof

ileQ

uest

ions

Mea

nI

Bra

ssfit

tings

,fau

cets

,an

dva

lves

are

gold

enye

llow

inco

lor,

sim

ilart

oco

pper

inap

pear

ance

,or

are

plat

edwi

thch

rom

e,B

rass

isco

mpo

sed

prim

arily

oftw

om

etal

s,co

pper

and

zinc

.M

ostb

rass

esco

ntai

nle

adra

ngin

gfro

m2

perc

entt

o8

perc

ent.

That

lead

can

cont

amin

ate

the

wat

erco

ntac

tsu

rfac

ew

hen

itis

smea

red

onth

em

achi

ned

surf

aces

durin

gpr

oduc

tion.

Afte

r19

96,

bras

sfit

tings

inst

alle

din

drin

king

wat

erou

tlets

such

asfa

ucet

san

dw

ater

cool

ers

mus

tmee

tN

SFst

anda

rds

for

lead

cont

ent.

Whe

this

perc

enta

geis

cons

ider

edle

ad-f

ree

unde

rth

e19

86Sa

feD

rinki

ngW

ater

Act

Am

endm

ents

,so

me

cont

amin

atio

npr

oble

ms

stlI

may

occu

r.O

lder

bras

sfa

ucet

sm

ayco

ntai

nhi

gher

perc

enta

ges

ofle

adan

dle

adso

lder

inth

eir

inte

rior

cons

truct

ion

and

pose

cont

amin

atio

npr

oble

ms.

Not

eth

atyo

urst

ate

orlo

cal g

over

nmen

t may

have

impo

sed

this

stan

dard

prio

rto

1988

.

The

degr

eeto

whi

chle

adwi

llle

ach

from

bras

spr

oduc

tsco

ntai

ning

allo

ysw

ithle

ssth

an8

perc

entl

ead

isde

pend

ent u

pon

the

corr

osiv

enes

sof

the

wat

eran

dth

em

anuf

actu

ring

proc

ess

used

tode

velo

pth

epr

oduc

t.A

stud

yre

veal

edth

atfa

bric

ated

fauc

ets

tend

toco

ntrib

ute

less

lead

toth

ew

ater

than

fauc

ets

man

ufac

ture

dby

the

perm

anen

t mol

dpr

oces

s,re

gard

less

ofth

eam

ount

ofle

adin

thea1oy.

Inre

spon

seto

are

quire

men

t oft

he19

96SD

WA

,EP

Aw

orke

dw

ithth

epl

umbi

ngin

dust

ryan

dN

SFIn

tern

atio

nal

tode

velo

pa

volu

ntar

yin

dust

ryst

anda

rdth

atis

desi

gned

tom

inim

ize

the

amou

nts

ofle

adbe

ing

leac

hed

from

thes

epr

oduc

ts.T

his

stan

dard

isN

SF/A

NSI

Stan

dard

61,

Sect

ion

9.Si

nce

1998

,all

purn

bing

fixtu

res

for

use

asdr

inki

ngw

ater

supp

lym

ust

mee

tthi

sst

anda

rd, Y

oush

ould

requ

ireN

SF!

AN

SI61

certi

ficat

ion

onall

drin

king

wat

ersy

stem

prod

ucts

purc

hase

d.In

clud

ea

copy

ofth

eN

SF)A

NSI

61ce

rtif

oate

asa

requ

irem

ento

nyo

urpu

rcha

seor

ders

.Th

edi

strib

utor

orm

anuf

actu

rer

can

prov

ide

you

with

alis

tof

certi

fied

prod

ucts

.Y

oush

ould

requ

ireN

SF/A

NSI

61ce

rtific

atio

non

alldr

inki

ngw

ater

syst

empr

oduc

tsus

edin

new

cons

truct

ion

and

info

rmyo

urar

chite

cts

and

revi

seyo

urbu

ildin

gsp

ecifi

catio

ns.

Plum

bing

Prof

ileQ

uest

ions

5.A

rebr

ass

fittin

gs,f

auce

ts,

orva

lves

used

inyo

urdr

inki

ngw

ater

syst

em?

(Not

e:M

ost f

auce

tsar

ebr

ass

onth

ein

side

.)

You

may

wan

tto

note

the

loca

tions

ona

map

ordi

agra

mof

your

faci

lity

and

mak

eex

tens

ive

note

sth

atw

ould

faci

litat

efu

ture

anal

ysis

ofle

adsa

mpl

ere

sults

.

6.H

owm

any

ofth

efo

llow

ing

outle

tspr

ovid

ew

ater

Inad

ditio

nto

lead

com

pone

nts

inth

epl

umbi

ngsy

stem

,le

adso

lder

sor

lead

inth

ebr

ass

fittin

gsan

dva

lves

for

cons

umpt

ion?

Not

eth

elo

catio

ns,

used

inso

me

taps

,bu

bble

rs,

and

refr

iger

ated

wat

erco

oler

sm

aybe

sour

ces

ofle

ad.

Itis

impo

rtant

toid

entif

yth

elo

catio

nsof

allsu

chdr

inki

ngw

ater

outle

ts.

Fauc

ets

inre

stro

oms

shou

ldno

t be

used

toob

tain

.W

ater

Coo

lers

wat

erfo

rdrin

king

.A

lthou

ghth

eym

aybe

adeq

uate

forw

ashi

ngha

nds,

they

may

not

beap

prop

riate

for

.B

ubbl

ers

drin

king

purp

oses

.Y

oum

ayco

nsid

erpo

stin

g‘d

ono

tdrin

k”si

gns.

eIc

eM

aker

s.

Kitc

hen

Tap

s.

Drin

king

Foun

tain

sor

Tap

s

10V

ersi

on1.

1Ju

ly21

,20

16(N

JDEP

)

Freq

uent

leak

s,ru

st-c

olor

edw

ater

,an

dst

ains

onfix

ture

s,di

shes

,an

dla

undr

yar

esi

gns

Dfco

rros

ive

wat

er.

Blu

e-gr

een

depo

sits

onpi

pes

and

sink

sin

dica

teco

pper

corr

osio

n;br

own

stai

nsre

sult

from

the

corr

osio

nof

iron.

Whe

resu

chsi

gns

occu

r,hi

ghle

vels

ofle

ad,

copp

er,

and

iron

may

bepr

esen

tin

the

wat

er.

Lead

can

accu

mul

ate

with

iron,

whi

chca

nfo

rmse

dim

ents

that

are

hard

tore

mov

e.Pe

rman

ently

out o

fser

vice

wat

erou

tlets

are

outle

tsth

atar

eno

long

erbe

ing

used

and

the

fact

ypl

ans

tode

com

mis

sion

inth

efu

ture

.

Tem

pora

rily

outo

f ser

vice

wat

erou

tlets

are

outle

tsth

atre

quire

repa

iror

repl

acem

enta

ndwf

llbe

putb

ack

inse

rvic

eon

ceth

eyar

eop

erat

iona

l.

______

Plum

bing

Prof

ileQ

uest

ions

Wha

tYou

rAns

wer

sto

the

Plum

bing

Prof

He

Que

stio

nsM

ean

7.H

asyo

ursc

hool

chec

ked

the

bran

dsan

dm

odel

sW

ater

cool

ers

may

bea

maj

orso

urce

ofle

adco

ntam

inat

ion.

The

Fede

ral

Con

sum

erPr

oduc

tSaf

ety

ofw

ater

cool

ers

and

com

pare

dth

emto

the

list o

fC

omm

issi

onne

gotia

ted

anag

reem

entw

ithH

alse

yTa

ylor

thro

ugh

aco

nsen

tord

erag

reem

ent

publ

ishe

din

reca

lled

wat

erco

oler

sin

App

endi

xH.

iN

ote

the

June

1990

topr

ovid

ea

repl

acem

ento

rre

fund

prog

ram

that

addr

esse

sall

the

wat

erco

oler

slis

ted

byEP

A.lo

catio

nsof

any

reca

lled

cool

ers.

asha

ving

lead

-line

dta

nks.

Hal

sey

Tayl

orw

asth

eon

lyco

mpa

nyid

entif

ied

byEP

Aas

man

ufac

turin

gso

me

wat

erco

oler

sw

ithle

ad-li

ned

tank

s.A

dditi

onal

ly, s

ome

cool

ers

man

ufac

ture

dby

EBCO

had

abu

bble

rva

lve

and

one

sold

ered

join

t tha

tcon

tain

edle

ad.

See

Atta

chm

ent H

iof

this

docu

men

t for

asu

mm

ary

ofEP

A’s

list o

fwat

erco

oler

sfo

und

toco

ntai

nle

ad.

Use

the

list t

ohe

lppr

iorit

ize

your

sam

plin

g.If

your

wat

erco

oler

islis

ted

asha

ving

ale

ad-li

ned

tank

,yo

ush

ould

not

use

the

wat

erfo

r drin

king

,an

dyo

ush

ould

rem

ove

the

cool

erim

med

iate

lyas

thes

eco

oler

spo

seth

ehi

ghes

t risk

ofco

ntam

inat

ion.

8.A

reth

ere

any

sign

sof

corr

osio

n,su

chas

freq

uent

leak

s,ru

st-c

olor

edw

ater

, or

stai

ned

dish

esor

laun

dry?

Not

eth

elo

catio

ns.

9.A

reth

ere

any

outle

tsth

atar

eno

tope

ratio

nal

and

ther

efor

eou

t of s

ervi

ce?

Perm

anen

tly?

Tem

pora

rily?

11V

ersi

on1.

1Ju

ly21

,20

16(N

JDEP

)


Inventory

Att

achm

entC

-D

rink

ing

Wat

erO

utle

tIn

ven

tory

(Com

plet

efo

rea

chsc

hool

)

____

____

____

____

____

____

____

____

____

____

____

Add

ress

:

Gra

de

Lev

els:

6-8

&A

DM

IN__

___

Yea

rS

choo

lC

onst

ruct

ed:

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1936

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ovat

ed/A

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ions

:

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Typ

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ion

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pera

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ater

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omm

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/N)

Cor

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Fitti

ngs,

Scre

enA

ctiv

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(YIN

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ake

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etFa

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ile.

Sign

sof

corr

osio

nde

tect

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such

asbu

tno

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tofr

eque

ntle

aks,

rust

-col

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orst

aine

dfi

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Com

plet

ed:

Ver

sion

1.1

July

21,

2016

(NJD

EP)

E____

1I_

___

__jz

___j_

____

Ver

SOfl

1.1

Juiy

2120

16(N

JDEP

)



Attachment D - Filter Inventory(Complete for each school)

Name of School: ROBERGE ANNEXGrade Levels: 6-8 & ADMIN_______

Address: 609 Westwood aveRiver Vale NJ 07675

Individual School Project Officer Signature: Date:

DateVersion ()

Sample Location /Code

Brand TTYPe(Make &Model)

DateInstalledorReplaced

ReplacementFrequency

NSFCertifiedfor LeadReduction

WATERSENTRY351299C

MINANNUALLY

YIN

YES

----.—____

-—- L_____— -

RA-WC-HW-305ELKAY

2 ELKAY WATER MIN YESRA-WC-HW-209 SENTRY3 ANNUALLY

51299C3RD

ELKAY WATER MIN YESRA-WC-HW-302 SENTRY3 ANNUALLY

51299C

Version 1.1 July ifS, 2016 (NJDEP)


(Rvervile Public Schools) Sampling PlanDate

Version 0Attachment E - Fu;g Log

(Complete br each school as applicable)

Name of School: _ROBERGE ANNEX

Address: 609 WESTWOOD AVE Rivervale NJ07675

________________

__________________________________

Grade Levels:_6-8 &ADMIN


_____________________

Date:

Sample Location Sample Date Time Duration of Reason forDescription Location Flushing FlushingCode

ACROSS FROM HW-305ROOM

#3O5HALLWAYWATER COOLER

1 FLOOR RA-WCACROSS FROM HW-209

ROOM#209WATER COOLER

_______

2FFLOOR RA—WCNEAR ROOM#302 HW—302WATER COOLER


(Rivervae Public Schools) Sampling Plan

DateVersion 0

Version 1,1 July 15, 2016 (NJDEP)


Use Certification

(INSERT SCHOOL DISTRICT NAME) Sampling PlanD ate

Version 0

Attachment F - Pre — San J•i, Water Use Certification(Complete for each school)


School Name:

______


_____________________________________________________


________________________________________________________


__________________________________________________

I have read the (1NSERi SullOOl. I)ISikI(T NA!\iF) Lead Drinking Water TestingSampling Plan and Quality Assurance Project Plan and I am certifying that samples werecollected in accordance with these plans.

Time: Date:

Time: Date:

Signature Date



Flush Tag


PLUS I-I TAG

Water outlet sampling n piogress. Please do not use water

School District Name: — ( lSEkT 5(11001. 1)1STRIUT NANIE) Date Flushed:


Is the fountain fiont cover removed for the sampler to determine the reservoir type (circle one):YES/NO


______________________________________

Signature:

* Water within the school distribution system should sit in the pipes unused for at least eight (8)hours after flushing but not more than 48 hours before a sample is taken f



Roberge ElementarySchool

MUSIC ROOM#58R-CL-58 —BUB

11TH HALLWAY #73 WATER COOLERR-HW -73- WC

Attachment A - List of (Rivervale Public SchoolsPhorty for Sarnpng

DATE OF CERTRED NOTESSCHOOL NAME Roberge SAMPUNG LABORATORY

11 ROOM #22 R-CL-2.2A- BUB

2 ROOM #23 R-CL-233 -BUB

3R0 HALLWAY R-HW 24-WC

4 ROOM#24 R- CL-24B- BUB

5TH NURSES OFFICE ROOM#16R-N-16-_SIN 1<

6T11 HALLWAY #17 WATER COOLERR—HW- 17-WC

7TH ROOM#36 R-CL-36A- BUB

8TH HALLWAY #51 WATER COOLERR-_HW_51- WC

9TH FACULTY #55 ROOM SINKR-_FR-55-SINK



Att

achm

ent

B-

Plu

mbin

gP

rofi

le

Not

e:C

om

plete

fo

reach

school.

For

ad

ditio

nal

in

fo

rm

at/on

see

th

eU

SE

PA

pu

blicatio

n,

The

3T

sfor

Red

ucin

gL

ead

in

Drin

kin

g‘V

ater

inS

choo

!s

Nam

eof

Sch

ool:

_R

ober

ge

____________________________________________

Gra

deL

evel

s:K

-5A

ddre

ss:

_617

Wes

twoo

dav

e_____________________________________________

Indi

vidu

alsc

hool

proj

ect

offi

cer

Sig

natu

re:

____

____

____

____

____

____

____

_

Dat

e:

Quest

ions

Answ

ers

Bac

kgro

und

info

rmat

ion

1.W

hat

yea

rw

asth

eor

igin

albu

ildi

ngco

nst

ruct

ed?

1958

Wer

ean

ybu

ildi

ngs

orad

diti

ons

added

toth

eor

igin

al19

66fa

cili

ty?

2001

2.If

the

buil

ding

was

const

ruct

edor

repa

ired

afte

r19

86,

Not

sure

was

lead

-fre

epl

umbi

ngan

dso

lder

util

ized

?W

hat

type

ofso

lder

was

use

d?

Doc

umen

tal

llo

cati

ons

whe

rele

adso

lder

was

used

.3.

Whe

rear

eth

em

ost

rece

nt

plum

bing

repa

irs

and

Loc

atio

n:20

01ne

ww

ing

Des

crip

tion

:re

pla

cem

ents

?

4.W

ithw

hat

mat

eria

lsis

the

serv

ice

conn

ecti

on(t

hepi

peM

ater

ial:

stee

lne

ww

ater

mai

n20

01th

atca

rrie

sw

ater

toth

esc

hool

from

the

publ

icw

ater

syst

em’s

mai

nin

the

stre

et)

mad

e?L

ocat

ion:

stora

ge

room

#13

Wher

eis

the

Ser

vice

Lin

elo

cate

d?

(Thi

sis

the

PO

Elocation.)

_______________________________

____________________________________________________

5.Is

ther

epo

int

ofen

try

(PO

E)

orpo

int

ofuse

(PO

U)

YI

Ntr

eatm

ent

inuse

?T

ype:

Elk

ayw

ater

filte

rL

ocat

ion:

drin

king

sourc

es

1V

ersi

on1.1

July

21,

2016

(NJD

EP)

—

Answ

ers

7

6.A

reth

ere

tank

sin

your

plum

bing

syst

em(p

ress

ure

tank

s,N

Ogr

avit

yst

orag

eta

nks)

?

7.D

oes

the

scho

olha

vea

filte

rm

aint

enan

cean

dop

erat

ion

YE

Spr

ogra

m?

Ifso

,w

hois

resp

onsi

ble

for

this

prog

ram

?B

UIL

DIN

GS

AN

DG

RO

UN

DS

DIR

EC

TO

RW

hat

isth

epr

oces

sfo

rad

ding

filt

ers?

8.H

ave

acce

ssib

lesc

reen

sor

aera

tors

onou

tlet

sth

atN

Opr

ovid

edr

inki

ngw

ater

been

clea

ned?

Doe

sth

esc

hool

have

asc

reen

orae

rato

rm

aint

enan

ceA

SN

EE

DE

Dpr

ogra

m?

9.H

ave

ther

ebe

enan

ycom

ain

tsab

out

bad

(met

allic

)N

Ota

ste?

Loc

atio

n:N

ote

loca

tion

(s).

10.

Rev

iew

reco

rds

and

cons

ult

with

the

publ

icw

ater

supp

lier

tode

term

ine

whe

ther

any

wat

ersa

mple

sha

vebe

enta

ken

inth

ebu

ildin

gfo

ran

yco

ntam

inan

ts.

Ifso

,id

entif

y:.

Nam

eof

cont

amin

ant(

s).

Con

cent

rati

ons

foun

d.

pHle

vel

Iste

stin

gdo

nere

gula

rly

atth

ebu

ildi

ng?

YE

SLE

AD

INV

VA

TER

1 1.

Oth

erpl

umbi

ngba

ckgr

ound

ques

tion

sin

clud

e:.

Are

blue

prin

tsof

the

build

ing

avai

labl

e?N

O.

Are

ther

ekn

own

plum

bing

“dea

d-en

ds”,

low

use

area

s,ex

isti

ngle

aks

orot

her

“pro

blem

area

s”?

NO

Are

reno

vati

ons

plan

ned

for

any

ofth

epl

umbi

ngsy

stem

?N

O

Ver

sion

1.1

July

21,

2016

(NJD

EP)

Qu

est

ion

sA

nsw

ers

Wal

k-T

hrou

ghT

hese

ques

tion

ssh

ould

be

add

ress

eddu

nng

the

wal

k-th

roug

hof

the

faci

lity,

whi

le4

C-

Dri

nkin

gW

ater

Out

let I

nven

toy

isbe

ing

com

plet

ed

1.C

onfi

rmth

em

ater

ial

ofS

ervi

ceL

ine

visu

ally

.—

2.C

onfi

rmth

epre

sence

ofP

OE

orP

OU

trea

tmen

t.

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

_

3.W

hat

are

the

pota

ble

wat

erpi

pes

mad

eof

inyo

urfa

cilit

y?C

OP

PE

RL

ead

•P

last

ic

•G

alva

nize

dM

etal

•C

ast

Iron

•C

opper

•O

ther

Not

eth

ew

ater

flow

thro

ugh

the

buil

ding

and

the

area

sth

atre

ceiv

ew

ater

firs

t,an

dw

hich

area

sre

ceiv

ew

ater

last

.4.

Are

elec

tric

alw

ires

gro

un

ded

toW

ater

Pip

es?

YE

SN

ote

loca

tion

(s).

Loc

atio

n:S

TO

RA

GE

RO

OM

___

________

__

__

____________

__

__

__

__

__

__

_

113

5.A

rebra

ssfi

ttin

gs,

fauce

ts,

orva

lves

use

din

your

drin

king

Com

plet

ein

“Bra

ss”

Col

umn

inA

ttac

hmen

tC

-W

ater

Out

let

Inve

ntor

y.w

ater

syst

em?

YE

SN

ote

that

mos

tfa

uce

tsar

eb

rass

onth

ein

side

.D

ocum

ent

the

loca

tion

sof

any

bra

ssw

ater

outl

etto

besam

pled.

______________________________________________________

6.L

ocat

eal

ldr

inki

ngw

ater

outl

ets

(i.e

.w

ater

cool

ers,

Com

plet

ein

Att

achm

ent

C-W

ater

Out

let

Inve

ntor

y.bu

bble

rs,

ice

mac

hine

s,ki

tche

n!fo

odpr

epsi

nks,

etc.

)in

the

faci

lity.

3V

ersio

n1.1

July

21,2

016

(NJD

EP)

Questi

LA

nsw

ers

7.H

ave

the

bran

dsan

dm

odel

sof

the

wat

erco

oler

sin

the

YE

Ssc

hool

been

com

pare

dto

the

list

ofre

call

edw

ater

cool

ers

inth

eT

oolk

it?

Rec

alle

dD

rink

ing

Wat

erF

ount

ains

Typ

eM

ake

and

Mod

el8.

Hav

esi

gns

ofco

rros

ion,

such

asfr

eque

ntle

aks,

rust

-C

ompl

ete

in“S

igns

ofC

orro

sion

”co

lum

nin

Att

achm

ent

C-

Dri

nkin

gco

lore

dw

ater

,or

stai

ned

fixt

ures

,di

shes

,or

laun

dry

been

Wat

erO

utle

tIn

vent

ory.

dete

cted

?N

ote

the

loca

tion

sof

wat

erou

tlet

s.9.

Are

ther

ean

you

tlet

sth

atar

eno

top

erat

iona

lan

dN

Oth

eref

ore

out

ofse

rvic

e?P

erm

anen

tly?

Tem

pora

rily

?I C

ompl

ete

“Ope

rati

onal

Col

umn”

inA

ttac

hm

ent

C-

Dri

nkin

gW

ater

Out

let

Inve

ntor

y.

Typ

e!L

ocat

ion

Des

crip

tion

Per

man

entl

y

Tem

pora

rily

4Ve

rsion

1.1Ju

ly21

,201

6(N

JDEP

)


Inventory

Nam

eof

Sch

ool:

RO

BE

RG

ER

IVE

RV

AL

EN

J07

675

Att

achm

ent

C-

Dri

nkin

gW

ater

Outl

etIn

ven

tory

(Cor

npl

ete

for

each

scho

ol)

_____

Add

ress

:61

7W

ES

TW

OO

DA

VE

Gra

deL

evel

s:K

-5_1

966,

2001

Yea

rS

choo

lC

onst

ruct

ed:1

958

Ren

ovat

ed/A

ddit

ions

:

Indi

vidu

alsc

hool

proi

ect

offi

cer

Nam

e/S

igna

ture

:D

ate

Com

plet

ed:

‘Num

ber

outle

tsst

arti

ngat

the

clos

est

outle

t to

the

Poi

ntof

Ent

ry(P

OE

).2

Doc

umen

tif

perm

anen

tly

orte

mpo

rari

lyou

tof

serv

ice

onth

eA

ttac

hmen

t B-Y

ES

Plum

bing

Prof

ile.

Sign

sof

corr

osio

nde

tect

ed,

such

asbu

tno

tlim

ited

tofr

eque

ntle

aks,

rust

-col

ored

wat

er,

orst

aine

dfi

xtur

es,

dish

es,

orla

undr

y.‘

Doc

umen

ton

Att

achm

ent

D-

Filte

rIn

vent

ory.

1

jTT

ype

Loc

atio

nC

ode

Ope

rati

onal

2Si

gns

ofii

er

Bra

ssA

erat

or!

Mot

ion

Chil

ler

1W

ater

Coo

ler

Com

men

ts(Y

/N)

Cor

rosi

on(Y

IN)

Fitti

ngs,

Scre

enA

ctiv

ated

(Y/N

)Fa

ucet

s(Y

IN)

(Y/N

)(Y

IN)

or valv

es?

ryn)

1B

UB

BL

ER

RO

OM

#22

R-C

L22

A-

YE

SN

OY

ES

YE

SN

ON

ON

OE

LK

AY

BU

B2

BU

BB

LE

RR

OO

M#2

3R

-CL

-23-

YE

SN

OY

ES

YE

SN

ON

ON

OE

LK

AY

3W

AT

ER

HA

LL

WA

YR

-HW

24-

YE

SN

OY

ES

YE

SN

ON

OY

ES

EL

KA

YL

ZS

F8I

0303

1811

CO

OL

ER

24W

CA

4B

UB

BL

ER

RO

OM

#24

R-C

L-2

4B-

YE

SN

O]Y

ES

YE

SN

ON

ON

OEL

KA

YBU

BI_

__

5SI

NK

RO

OM

#16

R-N

-16-

YE

SN

OY

ES

YE

SY

ES

NO

NO

GE

RB

EN

UR

SE

NK

____________

R

Ver

sion

1.1

July

21,

2016

(NJD

EP)

0LUD

(0

(“3

(N

a<1)

a)>


Attachment D - Filter Inventory(Complete for each school)

RIVERVA[E Sampling Plan

DateVersion 0

Name of School: ROBERGELevels: K-5

Address: —

617WESTWOOD AVERIVERVALE NJ07675

Grade

Sample Location /Code

ELKAYWATERSENTRYVii51299C

DateInstalledorReplaced

NSFCertifiedfor LeadReduction

YIN


rad(Make &Model)

Date:/

ReplacementFrequency

R-CL22A BUB ELKAY/

YEARLY ASNEEDED

YES

R-CL-23BUB ELKAY ELKAY YEARLY AS YESWATER NEEDEDSENTRY

/ Vii‘ 51299C

R-HW24-WC ELKAY ELKAY YEARLY AS YESWATER NEEDEDSENTRY

/ vii51299C

R-CL-24B-BUB ELKAY ELKAY YEARLY AS YESWATER NEEDEDSENTRYVii5i299C

R-N-16 SINK ELKAY ELKAY YEARLY AS YESLWATER

[______NEEDED


C’)

0•

= C 01

r”)

0)

C iD m -U

-w

> 3 -9- 5.

I-n

o

o


RIVERVA[.E Sampling PlanDate

\Iersion 0Attachment E - F1ushng Log

(Complete for each school as applicable)

Name of School:ROBERGE

SCHOOL____

Address:617 WESTWOOD AVE RIVERVALE NJ07675

Grade Levels:K-5

/Individual School Project Officer Signature:

_____________________

Date:

Sample Location Sample Date Time Duration of Reason forDescription Location Flushing FlushingCode

BUBBLER R-CL-22A-CLASSROOM 22 BUB

BUBBLER R-CL-23-CLASSROOM23 BUB

WATER COOLER R-HW-24-HAL LWAY# 24 WC

BUBBLER R-CL24B-CLASSROOM 24 BUB

SINK R-N-16-NURSES SINK

OFFICE#1 6WATER COOLER R—HW-17-

HALLWAY#17 / WCBUBBLER / R—CL-36-

CLASSROOM 36 BUBWATER COOLER R-HW--51-

HALLWAY #51 WC/

SINK R-FR-55-FACULTY ROOM SINK

#55BUBBLER R-CL-58-

CLASSROOM 58 BUBWATER COOLER R-HW-73-

HALLWAY#73 WC



Use Certification

(Rivervale Public Schools) Sampling Plan

Attachment F - Pre - Sampling Water Use Certification(Complete for each school)

DateVersion 0

TO BE COMPLETED BY THE <<SCHOOL NAME>> DISTRICT REPRESENTATIVE:School Name: Roberge Annex

Sample collection address:609 Westwood aveRiver Vale NJ 07675



Time: Date:

Time: Date:

I have read the Rivervaic Public Schools) Lead Drinking Water Testing Sampling Plan andQuality Assurance Project Plan and I am certifying that samples were collected in accordancewith these plans.

SignatureDate



Flush Tag


ELUS[l ‘FAG

Waler outlet sampling in progress. Please do not use water

School District Name: — R ivervale Public Schools) Date Flushed:School Name: R.obcrgc AnnexFlushing ProcessSchool Address: 609 West wood ave

River Vale NJ 07675StartTime:

Location of flushed outlet: End Time:

Is the fountain front cover removed [‘or the sampler to determine the reservoir type (circle one):YES /NO


__________________________________

Signature:

* ‘Water within the school distribution system should sit in the pipes unused for at least eight (8)hours after flushing but not more than 48 hours before a sample is taken. *

Note to the person responsible for the/lushing process:A. Turn-off lawn sprinkler outlet(s) until water sampling is complete.B. Make sure sampling outlets are accessible.

Version ii July 15, 2016 (NJDEP)

Woodside ElementarySchool

DATE OF CERTIFIED NOTESSCHOOL NAME WOODSIDE SAMPLING LABORATORY

] ROOM #128 W-CL-128-BUB

2ND ROOM #129 W-CL-129-BUB

3R0 ROOM #130 W-CL-130 —BUB

4TH ROOM #131 W-CL-131-BUB

5Th FACULTY ROOM #125W-FR-125_—SINK

6TH HALLWAY #123 WATER COOLERW-HW -123- WC -______________

71H ROOM #141 W-CL-141-BUB


ROOM #139 W-CL-139-BUB


jjTh HALLWAY#105 WATER COOLERW-HW-105-WC

12TH NURSE OFFICE ROOM#155 SINKW-N-155-SINI<

13TH MUSIC ROOM#164/165W-CL-164/165-BUB

14Th HALLWAY#209 W/VTER COOLERW-HW-209 -WC

Attachment A - List of (Rivervale Public SchoolsPriority for Sarnping


DATE OFSCHOOL NAME WOODSIDE SAMPLING

12TH NURSE OFFICE ROOM#155 SINKW-N-155-SINK

13TH MUSIC ROOM#164/165W-CL-164/165-B U B

14TH HALLWAY#209 WATER COOLER‘iN-HW-209_-VVC

Attachment A - List of (Rivervale Public SchoolsPriority for Sampling

CERTI FlEDLABORATORY

NOTES

15T ROOM W128 WCL-i28-BUR

2ND ROOM #129 W-CL--129-BUB

3° ROOM #130 W-CL-130--BUB

41[I ROOM #131 W-CL-131-BUB

5TH FACULTY ROOM #125W-FR-125 —SINK

6T11 HALLWAY #123 WATER COOLERW-HW -123-_WC

7TH ROOM #141 W-CL--141-BUB




11TH HALLWAY#105 WATER COOLERW-HW-105-WC



Att

achm

ent

B-

Plu

mbin

gP

rofi

leN

ote:

Com

plete

for

each

school.

For

additional

in

form

ation

see

the

US

EP

Apublication,

“T

he

3T

sfor

Reducing

Lead

in

Drinking

Water

in

Schools”

Nam

eof

Sch

ool:

Woo

dsid

eS

choo

lG

rade

Lev

els:

K-5

Add

ress

:_801

Riv

erva

lerd

___________

Indi

vidu

alsc

hool

proj

ect

offi

cer

Sig

natu

re:

Quesons

jAnsw

ers

Bac

kgro

und

Info

rmat

ion

1.W

hat

year

was

the

orig

inal

build

ing

cons

truc

ted?

195

8W

ere

any

buil

ding

sor

addi

tion

sad

ded

toth

eor

igin

al19

62up

per

leve

lfa

cilit

y?19

66lo

wer

area

nort

hw

ing

L20

01in

fill

clas

sroo

ms

,art

Im

usic

I 2.

lfth

ebu

ildin

gw

asco

nstr

ucte

dor

repa

ired

afte

r19

86,

Not

sure

was

lead

-fre

epl

umbi

ngan

dso

lder

util

ized

?W

hat

type

ofso

lder

was

use

d?

Doc

umen

tal

llo

cati

ons

whe

rele

adso

lder

was

used

.3.

Whe

rear

eth

em

ost

rece

ntpl

umbi

ngre

pair

san

dL

ocat

ion:

new

cons

truc

tion

Des

crip

tion

:re

plac

emen

ts?

2001

Wit

hw

hat

mat

eria

lsis

the

serv

ice

conn

ecti

on(t

hepi

peM

ater

ial:

Ste

elth

atca

rrie

sw

ater

toth

esc

hool

from

the

publ

icw

ater

Loc

atio

n:bo

iler

room

#109

syst

em’s

mai

nin

the

stre

et)

mad

e?W

here

isth

eS

ervi

ceL

ine

loca

ted?

(Thi

sis

the

PO

Ecati

on.)

5.Is

ther

epo

int

ofen

try

(PO

E)

orpo

int

ofus

e(P

OU

)Y

IN

trea

tmen

tin

use

?T

ype:

Elk

ayw

ater

filte

rL

ocat

ion:

drin

king

sour

ces

1V

ersi

on1.1

Juiy

21,

2016

(NJD

EP)

Dat

e:

SQ

ues

tions

Answ

ers

6.A

reth

ere

tanks

inyo

urpl

umbi

ngsy

stem

(pre

ssure

tank

s,Y

IN

grav

ity

stora

ge

tanks)

?In

room

109

7.D

oes

the

scho

olha

vea

filte

rm

ainte

nan

cean

dop

erat

ion

Yes

prog

ram

?If

so,

who

isre

sponsi

ble

for

this

prog

ram

?D

irec

tor

ofB

uild

ings

and

Gro

unds

Wha

tis

the

pro

cess

for

addi

ngfi

lter

s?8.

Hav

eac

cess

ible

scre

ens

orae

rato

rson

outl

ets

that

YI

Npr

ovid

edr

inki

ngw

ater

bee

ncl

eaned

?D

oes

the

scho

olha

vea

scre

enor

aera

tor

mai

nte

nan

ceA

snee

ded

prog

ram

?9.

Hav

eth

ere

bee

nan

yco

mpl

aint

sab

out

bad

(met

alli

c)Y

IN

tast

e?N

ote

loca

tion

(s).

Loc

atio

n:10

.R

evie

wre

cord

san

dco

nsul

tw

ithth

epu

blic

wat

ersu

ppli

erto

dete

rmin

ew

het

her

any

wat

ersa

mple

sha

vebe

enta

ken

inth

ebu

ildi

ngfo

ran

yco

ntam

inan

ts.

Ifso

,id

entif

y:.

Nam

eof

cont

amin

ant(

s).

Con

cent

rati

ons

foun

d.

pHle

vel

Iste

stin

gdone

regu

larl

yat

the

buil

ding

?Y

esle

adin

wat

er1

1.O

ther

plum

bing

back

grou

ndques

tions

incl

ude:

.A

rebl

uepr

ints

ofth

ebu

ildi

ngav

aila

ble?

No

.A

reth

ere

know

npl

umbi

ng“d

ead-

ends

”,lo

wuse

No

area

s,ex

isti

ngle

aks

orot

her

“pro

blem

area

s”?

Are

reno

vati

ons

plan

ned

for

any

ofth

epl

umbi

ngsy

stem

?N

o

Ver

sion

1.1Ju

iy21

,20

16(N

JDEP

)

Ip

Que

stio

nsA

sw

ers

Wal

k-T

hrou

ghT

hese

ques

tion

ssh

ould

bead

dre

ssed

duri

ngth

ew

alk-

thro

ugh

ofth

efa

cility

,whi

leA

ttac

hmen

tC

-D

rink

ing

Wat

erO

utle

tIn

vent

or,’

isbe

ing

com

plet

ed.

IC

onfi

rmth

em

ater

ial

ofS

ervi

ceL

ine

visu

ally

.2.

Con

firm

the

pre

sence

ofP

OE

orPO

Utr

eatm

ent.

3.W

hat

are

the

pota

ble

wat

erpi

pes

mad

eof

inyo

urfa

cilit

y?C

OP

PE

R.

Lea

d•

Pla

stic

.G

alva

nize

dM

etal

.C

ast

Iron

oC

oppe

r.

Oth

erN

ote

the

wat

erfl

owth

roug

hth

ebu

ildin

gan

dth

ear

eas

that

Lec

eive

wat

erfi

rst,

and

whi

char

eas

rece

ive

wat

erla

st.

4.A

reel

ectr

ical

wir

esgr

ound

edto

Wat

erP

ipes

?no

Not

elo

cati

on(s

).L

ocat

ion:

5.A

rebra

ssfi

tting

s,fa

ucet

s,or

valv

esus

edin

your

drin

king

Com

plet

ein

“Bra

ss”

Col

umn

inA

ttac

hmen

tC

-W

ater

Out

let

Inve

ntor

y.w

ater

syst

em?

Not

eth

atm

ost

fauc

ets

are

bra

sson

the

insi

de.

Doc

umen

tth

elo

cati

ons

ofan

ybra

ssw

ater

outl

etto

besa

mpl

ed.

6.L

ocat

eal

ldr

inki

ngw

ater

outl

ets

(i.e

.w

ater

cool

ers,

Com

plet

ein

Att

achm

ent

C-W

ater

Out

let

Inve

ntor

y.bu

bble

rs,

ice

mac

hine

s,ki

tche

n/fo

odpr

epsi

nks,

etc.

)in

the

faci

lity.

7.H

ave

the

bran

dsan

dm

odel

sof

the

wat

erco

oler

sin

the

Y/

Nsc

hool

been

com

pare

dto

the

list

ofre

call

edw

ater

cool

ers

inth

eT

oolk

it?

Rec

alle

dD

rink

ing

Wat

erF

ount

ains

Mak

ean

dM

odel

Typ

e

Ver

sion

1.1Ju

iy21

,20

16(N

JDEP

)

Queso

ns

Answ

ers

r8H

ave

sign

sof

corr

osio

nsu

chas

freq

uent

leak

s,ru

st-

Com

plet

ein

“Sig

nsof

Cor

rosi

on”

colu

mn

inA

ttac

hmen

tC

-D

rink

ing

colo

red

wat

er,

orst

aine

dfi

xtur

es,

dish

es,

orla

undr

ybe

enW

ater

Out

let

Inve

ntor

y.det

ecte

d?

Not

eth

elo

cati

ons

ofw

ater

outl

ets.

9.A

reth

ere

any

outl

ets

that

are

not

oper

atio

nal

and

YI

Nth

eref

ore

out

ofse

rvic

e?P

erm

anen

tly?

Tem

pora

rily

?C

ompl

ete

“Ope

rati

onal

Col

umn”

inA

ttac

hmen

tC

-D

rink

ing

Wat

erO

utle

tIn

vent

ory.

Typ

e!L

ocat

ion

Des

crip

tion

Per

man

entl

y

Tem

pora

rily

4\/e

rsion

1.1Ju

’y21

,20

16(N

JDEP

)


Inventory

Nam

eof

Sch

ool:

WO

OD

SID

ES

CH

OO

L

Att

achm

ent

C-

Dri

nkin

gW

ate

rO

utl

etIn

vento

ry(C

orn

plet

efo

rea

chsc

hool

)

Add

ress

:

\._

-,

Gra

deL

evel

s:K

-5

_____

Yea

rS

choo

lC

onst

ruct

ed: 1

958

1966

2001

______

Ren

ovat

ed/A

ddit

ions

:

Indi

vidu

alsc

hool

proj

ect

offi

cer

Nam

e/S

igna

ture

:D

ate

Com

plet

ed:

Num

ber

outle

tsst

alli

ngat

the

clos

est

outle

tto

the

Poi

ntof

Ent

ry(P

OE

).D

ocum

ent

ifpe

rmar

entl

vor

tem

pora

rily

out

ofse

rvic

eon

the

Att

achm

ent

B-

Plu

mbi

ngP

rofi

le.

Sign

sof

CO

ITO

Sio

nde

tect

ed,

such

asbu

tno

tli

mit

edto

freq

uent

leak

s,ru

st-c

olor

edw

ater

,or

stai

ned

fixt

ures

,di

shes

,or

laun

dry.

Doc

umen

ton

Att

achm

ent

D-

Fil

ter

Inve

ntor

y.

1

Typ

eL

ocat

ion

Cod

e[O

per

atio

nal

2Si

gns

of

Fil

ter

4B

rass

Aer

ator

!M

otio

nC

hille

rW

ater

Coo

ler

Com

men

ts.

(Y/N

)C

orro

sion

(Y/N

)Fi

tting

s,Sc

reen

Act

ivat

ed(Y

iN)

Mak

eM

ode)

Fauc

ets

(Y/N

)(Y

/N)

::.

(Y/N

)or va

lves

?(Y

/N)

ISI

NK

NU

RS

EW

-NR

155-

YE

SN

OY

ES

YE

SY

ES

NO

NO

GE

RB

E2

RO

OM

#155

SR

1B

UB

BL

ER

MU

SIC

1W-1

64/1

65Y

ES

NO

YE

SY

ES

NO

NO

NO

ELK

AY

3R

OO

MB

UB

164/

165

1W

AT

ER

iH

AL

LW

AY

IW-H

W-

YE

SN

OY

ES

YE

SN

ON

OY

ES

ELK

AY

EH

FA81

0507

2142

4C

OO

LE

R#2

0920

9-W

CG

9

LJ—

1

Ver

sion

1.1Ju

ly21

,20

16(N

JDEP

)

#125

wS

I

6W

AT

ER

HA

LL

WA

YW

-HW

-Y

ES

NO

YE

SY

ES

NO

NO

YE

SEL

KA

YL

ZS

8W13

0520

40C

OO

LE

R#1

2312

3-W

CS

iC9

7B

UB

BL

ER

RO

OM

W-C

L-1

41-

YE

SN

OY

ES

YE

SN

ON

ON

OE

LK

AY

#141

BU

B8

BU

BB

LE

RR

OO

MW

-CL

-14O

-Y

ES

NO

YE

SY

ES

NO

NO

NO

ELK

AY

#140

BU

B1

BU

BB

LE

RR

OO

MW

-CL

-142

YE

SN

OY

ES

YE

SN

ON

ON

OEL

KA

Y0

#142

BU

B1

WA

TE

RH

AL

LW

AY

W-H

W-

YE

SN

OY

ES

YE

SN

ON

OY

ES

ELK

AY

EH

F8-1

9003

6433

1C

OO

LE

R#1

0510

5-W

C5

Ver

sion

1.1Ju

ly21

,20

16(N

JDEP

)


RIVERVAE Sampltng PlanDate

Version 0Attachment D - Filter Inventory

(Complete for each school)

Name of School: WOODS IDE_________________________________Grade Levels: K-5

Address: —

801 RIVERVALE RDRIVERVALE NJ07675


_____________________Date:

/

Sample Location I Brand Type Date Replacement NSFCode (Make & Installed Frequency Certified

Model) or for LeadReplaced Reduction

YIN

/

WATER YEARLY AS YESSENTRY’ NEEDEDvii51299C

W-CL-129- BUB ELKAY ELKAY YEARLY AS YESWATER NEEDEDSENTRYvii51299C

W-CL13O-BUB ELKAY ELKAY YEARLY AS YESWATER NEEDED

7 SENTRYI vii

51299CW-CL-i31-BUB ELKAY ELKAY YEARLY AS YES

WATER NEEDEDSENTRYvii51299C

W-FR125-SINK ELKAY ELKAY YEARLY AS YESWATER NEEDED


CD cn 0 = C-

= 0)

C m 0

rn > 3(T o

SENTRYvii51299C

RIVERVAL[ Samphng Plan

Date

Version 0

/

7

W-HW-209-WC ELKAY ELKAY YEARLY AS YESWATER NEEDEDSENTRYvii51299C



(RIVERVALE Sampling PlanDate

Version 0

Attachment E - Flushing Log(Complete for each school as applicable)

Name of School:WOODSIDESCHOOL

Address: _801 RIVERVALE ROAD

Grade Levels:K-5


______________________

Date:

Sample Location Sample Date Time Duration of Reason forDescription Location Flushing Flushing

____________

CodeBUBBLER W-CL-128-

CLASSROOM 128 BUBBUBBLER W-CL-129-



CLASSROOM 131 BUBSINK W-FR-125-

FACULTY ROOM SINK125

WATER COOLER W-HW-123-HALLWAY#123 WC

BUBBLER W-CL-141-CLASSROOM14I BUB

BUBBLER W-CL-140-CLASSROOM 140 BUB

BUBBLER W-CL-139-CLASSROOM 139 BUB

BUBBLER W-CL-142-CLASSROOM 142 BUBWATER COOLER W-HW-105-

HALLWAY#105 WCSINK W-N-155-

NURSES OFFICE SINK#155

BUBBLER W-CL


(RIVERVAE ) Sampling PlanDate

Version 0MUSIC ROOM 164/1 65-

#164/165 BUBWATER COOLER W-HW-209-

HALLWAY#209 WC

/

/

/

/



Use Certification


Attachment F - Pre - Water Use Certification(Complete for each school)

[) t e

Version ()

Time: Date:

Time: Date:

gnature Date


School Name:


_____________________________________________________


_______________________________________ ________


_____________________________________________________

I have read the F.iSFRT SUIIOOI. I)ISTkIUT N.AMI) Lead Drinking Water TestingSampling Plan and Quality Assurance Project Plan and I am certifying that samples werecollected in accordance with these plans.



Flush Tag


FLUSH TAG

Water outlet sampling in progress. Please do not use water

School District. Name: — ( ISEkT SCFJOOL I)ISIiI( ‘‘F NAME) Date Flushed:


Is the fountain front cover removed for the sampler to determine the reservoir type (circle one):YES /NO


______________________________________

Signature:

Water within the school distribution system should sit in the pipes unused for at least eight (8)hours after flushing hut not more than 48 hours before a sample is taken:



Appendix C: Chain of Custody

CLIENT INFORMATION

Name:

Address:

Client Rep:

BLDG ID:BLDG No/Name:

BLDG Address:

Contact Name & Numbers:

All containers are pre-cleaned/ 250 ml plastic bottles preserved w HNO3 @ pH<2 by field_ or to be preserved by lab_____________

CHAIN OF CUSTODY

Relinquished By: Received By: Time:

Ill.

__________________________________________________________________________________________

Page 22 of 23

POTABLE WATER SAMPLING FOR LEAD CONCENTRATION SAMPLE COLLECTION FORMLAB INFORMATION

SCHOOLIPROJECT INFORMATION

Name:

Address:Proj.Mgr:

SAMPLE DATA

(0) Yr. Built: (1) Yr.1 St Add.: (2) Yr. 2nd Add.: (3) Yr. 1 St Mod.: (4) Yr. 2nd Mod.:

SAMPLING TEAM: DATE OF SAMPLING:

Sample_Description ID (ID must match container label) I Drinking Water Outlet Information

G) I j— t3 - ICC 0 I u, o1

0) P I o o I TimeofC) ii)

. IE o c (‘3 U) Ez

0 > Sampled Outlet Location/Coordinates/number I collectionci‘3 L1 IL (I) Z Room Number C) U) (24hr)C,)

Method of shipment/delivery: . — Delivery Mail Courier

INSTRUCTIONS TO THE LABORATORY

Lab: Report Results to:both initial and follow up samples

Other:Follow QAPP instructions Contact:

Comments: Provide Laboratory Data Report (LDR) Package and Chain of Custody

Version 1,1 July21, 2016 (NJDEP)