Form DOH-360CUV - Water System Operation Report For Systems that Treat with Chlorine and or Ultravio 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Public Water System Name, Reporting Month/Year, and Date Report Submitted. Ensure the date format is MM/DD/YYYY.
3. Fill in the County and Town, Village or City fields accurately to reflect your system's location.
4. Indicate the Source Water Type(s) by checking the appropriate boxes for Surface, Ground, GWUDI, or Purchase options.
5. Complete the Public Water System ID section with your unique identifier.
6. Document the Treated water volume (gallons/day), Gaseous Cylinder weight (lbs.), and Chlorine used per day (lbs.).
7. Provide details on Chlorination Liquid Hypochlorite added to crock and record Free chlorine residual at entry point (mg/l).
8. Answer whether the UV Unit is Active and provide Intensity Meter readings if applicable.
9. Fill in additional details such as Chlorine Mix Ratio, dates for UV maintenance, alarm activation status, and operator information.

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