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Use to provide operational information about the water supply. Reference: FM 10-52.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — SUPPORT UNIT_______________________________(Designation of the Supporting Unit)

LINE 4 — FROM_______________________________________(DTG for Beginning of Period Applying to Operational Information)

LINE 5 — TO__________________________________________(DTG for End of Period Applying to Operational Information)

LINE 6 — POTABLE LOCATION _________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Potable Water Supply Point)


LINE 8 — POTABLE AVAILABLE _________________________(Gallons of Potable Water Available at Water Supply Point)

LINE 9 — POINT CAPACITY_ ___________________________(Daily Production Capacity in Gallons)

LINE 10 — WATER UNIT ________________________________(Name or Designator of Unit Providing Support Shown in Line 11)

LINE 11 — NONPOTABLE LOCATION____________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Nonpotable Water Supply Point)

LINE 12 — NONPOTABLE AVAILABLE____________________(Gallons of Nonpotable Water Available at Water Supply Point)

**Repeat lines 4 through 13 if necessary. Assign sequential line numbers to succeeding iterations; for example, first iteration 4 through 13; second iteration 4a through 13a; third iteration 4b through 13b; and so on.

LINE 13 — NONPOTABLE CAPACITY ____________________(Daily Production Capacity in Gallons)

LINE 14 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 15 — AUTHENTICATION___________________________(Report Authentication)

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