o Environmental Protection Agency DI\lision of Drinking and Ground Waten.

Verification of Lead Consumer Notice Issuance

Public Water System Name: __ Triad Middle School __

Public Water System 10 Number: _OH1134912 __ _

Monitoring Period: _July - Sept. 2012 ____ _

Return this completed form and a copy of a sent Lead Consumer Notice to Ohio EPA, DDAGW-Central Office, PO Box 1049, Columbus, OH 43216-1049 or Fax to (614) 644-2909 (receipt being no later than 90 days after the end of the monitoring period). Retain a copy of this report in your files with supporting documentation for a minimum of 12 years.

System Type Method of Delivery Date(s) of Delivery

Date(s) of ( ) mail ( ) hand delivery:

Community Systems Mail or hand delivery to location where samples were collected.

Nontransient Noncommunity (NTNC) or Certain Small Post near locations where Community Systems (e.g., samples were collected. Date notices posted: Correctional Institutions or (Post a minimum of 7 days.) Nursing Homes)

Notify parents, legal guardians or (x ) Newsletter (x ) e-mail

Additional Requirements for (x ) Other Method: __ Website Schools, Day Care Facilities, power of attomey of postings. updated 9/26/12 Nursing Homes, and Juvenile (e.g., by newsletter, e-mail, or

Correctional Institutions other method accepted by Ohio EPA) Date(s): _9/26/12

I hereby certify that the Lead Consumer Notice was issued to all locations that were sampled within 30 days of receiving sample results. Issuance was made by the method(s) indicated above in accordance with OAC Rule 3745-81-85.

Additionally, the attached copy of a Lead Consumer Notice is representative of what was issued to all locations.

Signature of Respo

1YJtt77 A/Cy.a¢? It Printed Name

For OEPA use only

q -",l 0 -12< Date

IYh ; ,()k4tO (1 c· >" ~tcr:((jif I.ei?' Title of Responsible 0 IClal

Consumer Notice Verification Received Date: - -----Consumer Notice Acceptable: ___ _ Consumer Notice Not Acceptable: __ _

(Rev. 9/11)

Consumer Notice of Tap Water Result Dear Consumer,

Triad Middle School is a public water system (PWS) responsible for providing drinking water that meets state and federal standards. A drinking water sample for lead was collected at this location and the result is:

Amount of Lead in water: <2.0 Action Level for Lead: 15 micrograms per liter (ug/L)

Location of sample: Main Hall Boys RR Sample collection date: 7-10-12 PWS's Lead 90th Percentile Value: 7.0

What Is Being Done?

Our g(/h percentile value for lead does not exceed the action level, therefore, there are no actions being implemented at this time other than sharing this consumer notice.

What Does This Mean?

Under the authority of the Safe Drinking Water Act, the U.S. Environmental Protection Agency (EPA) set the action level for lead in drinking water at 15 ug/L. This means PWSs must ensure that water from taps used for human consumption do not exceed this level in at least 90 percent of the sites sampled (90th percentile value). The action level is the concentration of a contaminant which, if exceeded, triggers treatment or other requirements which a PWS must follow. Because lead may pose serious health risks, the EPA set a Maximum Contaminant Level Goal (MCLG) of zero for lead. The MCLG is the level of a contaminant in drinking water below which there is no known or expected risk to health. MCLGs allow for a margin of safety.

What Are The Health Effects of Lead?

Lead can cause serious health problems if too much enters your body from drinking water or other sources. It can cause damage to the brain and kidneys, and can interfere with the production of red blood cells that carry oxygen to all parts of your body. The greatest risk of lead exposure is to infants, young children, and pregnant women. Scientists have linked the effects of lead on the brain with lowered IQ in children. Adults with kidney problems and high blood pressure can be affected by low levels of lead more than healthy adults. Lead is stored in the bones, and it can be released later in life. During pregnancy, the child receives lead from the mother's bones, which may affect brain development.

What Can I Do To Reduce Exposure to Lead if Found in My Drinking Water?

• Run your water to flush out lead. If water has not been used for several hours, run water for thirty seconds to two minutes before using it for drinking or cooking. This helps flush any lead in the water that may have leached from the plumbing.

• Use cold water for cooking and preparing baby formula. Do not cook with, drink water, or make baby formula from the hot water tap. Lead dissolves more easily in hot water.

• Do not boil water to remove lead. Boiling water will not reduce lead.

For More Information Please Contact: Mike Fry, MCF Technologies @(419) 560-0384, Matt Alexander, Triad Maintenance Supervisor@ (937) 826-3771, visit US EPA's Web site at www.epa.govllead, call the National Lead Information Center at aOO-424-LEAD, or contact your health care provider.

Oh · I Environmental 10 Protection Agency Division of Drinking and Ground Waters EPA 5105

DRINKING WATER LEAD AND COPPER MONITORING REPORT

PWS Name: PWSID: County: Population: Triad Middle School Champaign 370

OH1134912 PWS Address: Phone: Sampling begin date: Sampling end date: 8550 Brush Lake Road (937) 826-3771 7-10-12 7-10-12 North Lewisburg, Ohio 43060

Monitoring Schedule: D "6 month" or "optional" X "annual" or "triennial"

Return this completed form to Ohio EPA. DDAGW-Central Office, PO Box 1049, Columbus, OH 43216-1049 or Fax to (614) 644-2909 (receipt being no later than 10 days after the end of the monitoring period). Retain a copy of this report in your files with supporting documentation for a mi~imum of 12 years.

Lead and Copper Tap Monitoring (First-Draw Samples)

a. Number of sampling sites required: 5 I Number of samples analyzed: 5

If the number of samples analyzed is less than the standard number of sampling sites required for your water system, then explain why:

b. Were all sampling sites tier 1 sites? If no, explain: Built after 1987 ( ) Yes (x )No

c. Were 50% of your lead samples If no, explain: Built after 1987 from sites with Lead Service Lines? ( ) Yes (x ) No

d. Have any of your sampling sites If yes, state which sites and explain: Not aware of any changes changed since the last monitOring period? ( ) Yes (x ) No

e. 901n % Lead Level (mg/L) : 901n % Copper Level (mg/L) : 7.0 52.5

When the 90th % Lead Level is 0.0155 mg/L (or higher) or the 90th % Copper Level is 1.350 mg/L (or higher), contact your Ohio EPA district office within three business days for additional requirements.

I certify that each first-draw lead and copper sample col/ected for our water system was one liter in volume, was taken from a kitchen or bathroom cold-water tap or a drinking fountain, and, to the best of my knowledge, had stood motionless in the seNice line and in the interior plumbing of the sampling site for at least six hours. I further certify that each tap sample col/ected by residents was taken after the water system informed them of proper sampling procedures.

For Ohio Received EPA use Date:

only:

EPA 5105 (Rev. 4/11)

Monitoring Period:

9r1.o -/:/, /YJ.f; TT /J!(..A(1Wit;e Date Printed Name

Approved: ()Yes () No

Page 1 of __

Oh· I Environmental 10 Protection Agency OMr.ion of Drin1l;Ing and Ground Wate~ ~ EPA 5105 Appendix

DRINKING WATER LEAD AND COPPER MONITORING REPORT

Submit with Form EPA 5105 Page _2_ of _2_ pages

PWS Name: PWSID: Analytical Laboratory Name: Laboratory Certification No. : Triad Middle School Alloway 4053

OH 1134912 - ---

List samples sequentially by Laboratory Sample Number

Date of Time Laboratory Address of Sample Tap Type* Structure Interior Service Tier Lead Copper Sample Sample Sample Site and Type Plumbing Line 1,2, 3, Concn Concn

Taken Number Location SFR,MFR Material Material or (ug/L) (ug/L) Example: or BLDG Pb, Pb, Cu, or other 234 S Main St Example: CuPb>82, other Town OH 40000 B 2nd floor CuPb<83, or

other

7-10-12 12:14 M12-18124- 8099 Brush Lake Rd. Main Hall Bldg CuLP Cu Other <2.0 <10 01 NLewisburgOH43060 Boys R

7-10-12 12:15 M12-18124- 8099 Brush Lake Rd. Cafeteria Bldg CuLP Cu Other <2.0 23 02 NLewisbu[gOH43060 Girls R

7 -10-12 12:16 M12-18124- 8099 Brush Lake Rd. Cafeteria Bldg CuLP Cu Other <2.0 37 03 NLewisburgOH43060 Boys R

7-10-12 12:17 M12-18124- 8099 Brush Lake Rd. Sm Bldg CuLP Cu Other <2.0 22 04 NLewisburgOH43060 Handsink K

7 -10-12 12:18 M12-18124- 8099 Brush Lake Rd. Lg. Bldg CuLP Cu Other 12 68 05 NLewisburgOH43060 Kettle K

EPA 5105 Appendix (Rev. 4/11)

I

Ohio Environmental Protection Agency Division of Drlnhlng .nd Ground w.terw ~ EPA 5105 Appendix

DRINKING WATER LEAD AND COPPER MONITORING REPORT

= 1 ,- -T -- I - I :J -) "Tap type codes: B - bathroom cold water tap; D - drinking fountain; K - kitchen sink cold water tap; R - restroom sink cold water tap; 0 - other (with prior

Ohio EPA acceptance) Note: 1 mglL = 1000 ug/L

EPA 5105 Appendix (Rev. 4/11)