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Run: Water Storage Tank Disinfection and Return-to-Service Record (AWWA C652)

Record tank disinfection, chlorine dose, contact time, flushing, residuals, and the two consecutive coliform-absent samples needed before a water storage tan...

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Inspection Details

Tank identification and location recorded

Enter the tank name/ID, site address or facility name, and tank type.

Inspection date and time recorded critical (required)

Record the date and time the disinfection/return-to-service inspection was completed.

Inspector or competent person identified critical (required)

Enter the name and role of the person completing the record.

Tank status before disinfection

Select the condition that triggered disinfection.

Pre-Disinfection Preparation

Tank isolated from potable distribution system critical (required)

Verify the tank is isolated, valved off, or otherwise prevented from returning to service before clearance.

Yes No N/A

Interior cleaned and debris removed critical (required)

Confirm visible sediment, scale, debris, and standing water were removed before disinfection.

Yes No N/A

Access openings, vents, and appurtenances inspected for sanitary condition critical (required)

Verify hatches, vents, overflow, and related appurtenances were checked for contamination sources and sanitary condition.

Yes No N/A

Disinfection method selected critical (required)

Select the disinfection method used for this tank.

Note (optional)

Chlorination and Contact Time

Chlorine source and concentration documented critical (required)

Record the chlorine product used, concentration, and batch or lot number if available.

Applied chlorine dose recorded critical (required)

Enter the chlorine dose applied to the tank.

Note (optional)

Required contact time achieved critical (required)

Enter the actual contact time achieved before flushing or sampling.

Note (optional)

Chlorine residual measured after contact period critical (required)

Record the free chlorine residual measured at the end of the contact period.

Note (optional)

Flushing and Sampling

Tank flushed to remove spent disinfectant and debris critical (required)

Verify flushing was completed before bacteriological sampling and return-to-service consideration.

Yes No N/A

Flushing discharge disposed of in accordance with site requirements

Confirm discharge was managed per site, environmental, and utility requirements.

Yes No N/A

First bacteriological sample collected critical (required)

Record the result of the first sample collected after disinfection and flushing.

Note (optional)

Second consecutive bacteriological sample collected critical (required)

Record the result of the second consecutive sample required before return to service.

Note (optional)

Return-to-Service Authorization

All required bacteriological results acceptable before return to service critical (required)

Confirm both required consecutive samples are coliform-absent and any other required clearance criteria have been met.

Yes No N/A

Tank returned to service authorized critical (required)

Confirm the tank was authorized for return to service by the responsible utility representative or AHJ.

Yes No N/A

Deficiencies or non-conformances documented

List any deficiencies, corrective actions, retesting requirements, or hold points identified during the process.

Inspector signature critical (required)

Signature of the person completing the inspection and record.

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