Purpose and Clearance Standards for Lead in Drinking Water



Lead Clearance ReportWATER SAMPLE RESULTSProject/Site AddressAddress, City, ZipOccupantOccupant NamePhone #: ###-###-####HomeownerHomeowner NameHomeowner Address, City, ZipPhone #: ###-###-####ContractorContractor NameContractor Address, City, ZipPhone #: ###-###-####Clearance Date(s)DatePass/Fail Contents TOC \o "1-3" \h \z \u Purpose and Clearance Standards for Lead in Drinking Water PAGEREF _Toc35501854 \h 2General Description of Work Performed (Visual Assessment) PAGEREF _Toc35501855 \h 2Assessment of Sample Collection PAGEREF _Toc35501856 \h 2Water Sample Clearance Results PAGEREF _Toc35501857 \h 3Retesting of Water Samples Above Clearance Levels PAGEREF _Toc35501858 \h 3Recommendations PAGEREF _Toc35501859 \h 3Inspector Certification PAGEREF _Toc35501860 \h 4Appendix A – Site Map PAGEREF _Toc35501861 \h 5Appendix B – Photos PAGEREF _Toc35501862 \h 6Appendix C – Laboratory; Original Laboratory Analysis Reports; & Chain of Custody Form PAGEREF _Toc35501863 \h 9Purpose and Clearance Standards for Lead in Drinking WaterThe purpose of this report is to share drinking water sample results collected from your home after plumbing component and/or service line replacement. The U.S. Environmental Protection Agency (EPA) action level for lead in drinking water is a result above 15 parts per billion (ppb) or above 0.015 milligrams per liter (mg/L). For clearance, results must be below the EPA action level. General Description of Work Performed (Visual Assessment)Date of Visual Assessment: DATELocation of Plumbing ComponentActivityComponent Replaced?NSF/ANSI 61 (or equivalent) Certified?NotesLocationActivityYes/NoYes/NoNotesLocationActivityYes/NoYes/NoNotesLocationActivityYes/NoYes/NoNotesLocationActivityYes/NoYes/NoNotesAssessment of Sample CollectionClearance water sampling preparation protocol was reported by contractor/homeowner/representative to be performed correctly:All water sampling locations flushed for 5 minutesAerators removed, cleaned and replacedAll water sampling locations flushed for another 5 minutesWater not used for at least 6 hours (stagnation)Yes/NoConfirmed by:Contractor/ Homeowner / RepType of service line material verified at clearanceType of materialWas the service line replaced? If so, when? N/A if copperDATEWater Sample Clearance ResultsDate of Water Sample Collection: DATESample NumberFaucet locationWater sample representsResults [parts per billion (ppb)]Does sample exceed EPA action level?Pass or Fail#LocationFaucet/ interior/ service lineResultYes/NoPass/FailBRL = Below Reporting Limits; N/D = Not Detected. “P” samples = first draws; “A” samples = system draws. Retesting of Water Samples Above Clearance LevelsDate of Water Sample Collection: DATESample NumberFaucet locationWater sample representsResults [parts per billion (ppb)]Does sample exceed EPA action level?Pass or Fail#LocationFaucet/ interior/ service lineResultYes/NoPass/FailBRL = Below Reporting Limits; N/D = Not Detected. “P” samples = first draws; “A” samples = system draws. RecommendationsPlease use the recommendations below to reduce exposure to lead in water: Flush your pipes before using your water. If you have not used your water for several hours, flushing your pipes may reduce the amount of soluble (dissolved) lead in your drinking water.?To flush the pipes in your home, do any of the following for at least 5-minutes:Turn a faucet on all the way.Take a shower.Run a load of laundry.Run your dishwasher.After flushing your home’s water, run the water from individual faucets on cold for 1-2 minutes before using the water for drinking or cooking.Using a filter can reduce lead in drinking water. Both particulate and soluble lead can be safely removed from drinking water by using a water filter certified to reduce lead in drinking water. Look for filters that are tested and certified to NSF/ANSI Standard 53 for lead reduction.? Follow the manufacturer’s instructions to install the filter and maintain it. For help choosing a filter, use the?EPA guidance tool.Use cold filtered or flushed water for: Drinking, cooking, or rinsing foodMixing powdered infant formulaBrushing your teethDo not use hot water for drinking or cooking. Do not cook or drink water from the hot water tap. Lead dissolves more easily into hot water. Clean your aerator. Aerators (the mesh screens on your sink faucet) can trap pieces of particulate lead. Clean your drinking water faucet aerator at least every 6 months. If there Be mindful of recent disturbances or repairs to local water supply systems. Local water supply systems include water pipes that carry water to your home. These disturbances may release lead into your water. Inspector CertificationThe information contained in this report is a true and accurate representation of the conditions at this property at the time of lead clearance, based on the professional judgement of the person(s) who conducted and reported this clearance. NameDateMichigan Certified Lead Inspector/Risk Assessor # P- 0XXXXRisk Assessor E-Mail: email addressNote: A copy of this report must be provided to the client requesting the clearance and the property owner if they are different individuals.Appendix A – Site MapA site map of the property is included to identify sample locations as well as justify the number of large volume samples collected (if necessary). Appendix B – Photos CaptionCaptionCaptionCaptionCaptionCaptionCaptionCaptionCaptionCaptionCaptionCaptionAppendix C – Laboratory; Original Laboratory Analysis Reports; & Chain of Custody FormLABORATORY USEDMichigan Department of Environment, Great Lakes and EnergyDrinking Water Laboratory3350 N. Martin Luther King Blvd.P.O. Box 30270Lansing, MI 48909P: 517-335-8184ORIGINAL LABORATORY ANALYSIS REPORTS & CHAIN OF CUSTODY FORMAll original laboratory analysis reports and chain of custody form for any samples that were sent for testing are included in the following pages. ................
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