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The occurrence of pesticides in surface water systems was shown to be prevalent in rivers and lakes for those pesticides of high use and regulatory concern for drinking water protection. The inclusion of surface water in US policies for controlling the use and fate of pesticides in our environment is warranted based on the nearly 4,000 public water systems estimated to be at risk of non-compliance with at least one pesticide standard. Further, the cost-effectiveness of drinking water regulations for mitigating exposure to pesticides is questionable. While cost-effective regulations are desirable, their development is dependent on the reliability and depth of information on associated health effects, population exposure, and compliance impacts. Indications from the limited number of available studies are that these health concerns are more critical than the carcinogenic and chronic effects targeted for protection by drinking water standards. Therefore, the available risk assessments may not be targeting the most critical health effect end point.