NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Community Environmental Health
and Food Protection
Recreational Aquatic Spray Ground
Operation Report
at
Facility Name
(City, Village or Town)
Month:
20
UV Intensity (See back of form)
Intensity
Time
Feature(s)
Flow Rate
1 Test
(mW/cm2)
2
nd
(μW/cm2)
Test
Lamp(s)
Cleaned (√)
st
Intensity
(W/m2)
Time
Flow Rate
(GPM)
Filtration
Flow Rate
pH
Total (mg/l)
Free (mg/l)
3 Test
Time
Test
Alkalinity (mg/l)
rd
pH
Free (mg/l)
Time
2
pH
Total (mg/l)
Free (mg/l)
Time
1 Test
nd
Total (mg/l)
st
Turbidity (NTU)
Chemical Disinfection Residual (mg/l) and pH
Chlorine (Cl)
Bromine (Br)
Daily Cl/Br Use
□ gals or □ lbs.
Pad Cleaned (√)
Filter Cleaned (√)
Date
County
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
UV Setpoint Intensity: ___________________
(W/m2)
Filtration Design Flow Rate: _______________ GPM
Please see reverse side for important instructions
DOH – 4429 (6/07)
(mW/cm2)
(μW/cm2)
(See back of form)
Feature(s) Design Flow Rate: _______________ GPM
_____________________________________
Operator’s Signature
____________
Date
Recreational Aquatic Spray Ground Operation Report and Disinfection Instructions
Chemical Disinfection:
The spray ground water chemical disinfectant residual must be checked at least three times (3x) a day,
especially before and after periods of heavy use. Chlorine and bromine levels must be measured with
a DPD test kit.
1. The use of cyanuric acid or a chlorine compound containing cyanuric acid is prohibited.
2. Section 6-3.11(c) of Subpart 6-3 of the New York State Sanitary Code specifies the minimum
disinfectant residual as follows:
• When calcium hypochlorite or sodium hypochlorite is used for disinfection, a minimum
concentration of 2.0 mg/l free chlorine residual must be maintained and the maximum free
chlorine residual shall not exceed 10.0 mg/l.
• When bromine is used as the disinfectant, a minimum concentration of 4.4 mg/l bromine
residual must be maintained.
3. pH must be maintained between 7.2 and 7.8.
Ultraviolet Light (UV) Disinfection:
The ultraviolet light unit’s intensity meter reading must be monitored and recorded at least two times
daily. Each UV light system has a pre-established setpoint intensity that is necessary for adequate
disinfection. When the measured lamp intensity falls below the setpoint intensity, conditions causing
decreased ultraviolet light intensity at the sensor shall be evaluated and corrected. The ultraviolet
lamp(s) shall be replaced when the decreased ultraviolet light intensity is due to lamp failure.
Other Requirements:
A spray ground operator must notify the local health department (LHD) within 24 hours of any
incidence of illness associated with water quality and/or a serious injury that results in death, requires
resuscitation or referral to a hospital or other facility for medical attention.
A copy of the operation report must be maintained at the facility for 12 months. When required by the
permit-issuing official, a copy of the operation report shall be sent to the LHD.
List other operation and maintenance activities/services that are not specified on the front of this form.
Include UV lamp replacement(s), water contamination incidents, equipment/re-circulation system
repair, etc. LHD approval is required for equipment replacement or modification.
Date
DOH – 4429 (6/07)
Description of Activity/Service