Municipal water utilities across the Ohio and Tennessee River basins are actively evaluating treatment technologies to comply with the U.S. EPA 2024 National Primary Drinking Water Regulations (NPDWR) for per- and polyfluoroalkyl substances (PFAS). These regulations establish enforceable Maximum Contaminant Levels (MCLs) for PFOA and PFOS at 4 ng/L and introduce a Hazard Index (HI) framework for additional PFAS compounds. This presentation summarizes results from multiple full-scale–representative pilot studies evaluating a micro-sorbent adsorption process coupled with ceramic microfiltration (AquaPRS™) across a range of municipal water matrices. Pilot testing was conducted at six municipal sites representing groundwater, surface water, and reverse osmosis (RO) reject streams. Influent regulated PFAS concentrations ranged from approximately 20 ng/L to over 300 ng/L, with varying contributions from PFOA, PFOS, PFHxS, PFNA, and PFBS. The pilot systems were operated primarily in single-stage configurations to establish baseline performance, sorbent utilization, and operational stability. Ceramic membrane separation (0.1 µm nominal pore size) enabled continuous crossflow operation with closed-loop sorbent recovery and no routine backwash waste generation. Across all groundwater and surface water pilot sites, PFOA and PFOS were consistently reduced to below analytical detection limits, maintaining effluent concentrations below 4 ng/L and achieving Hazard Index values less than 1.0 for the duration of testing. Short-chain PFAS compounds, particularly PFBS, exhibited partial breakthrough in extended runs; however, effluent concentrations remained well below applicable EPA MCLs and did not govern system compliance. In surface water applications with variable natural organic matter (NOM), stable hydraulic performance was maintained using modest operational adjustments, such as intermittent coagulant addition, without compromising PFAS removal. RO reject testing demonstrated effective treatment of concentrated PFAS waste streams, achieving regulatory compliance while substantially reducing projected lifecycle costs relative to fixed-bed granular activated carbon (GAC). Measured sorbent loading capacities ranged from approximately 5 to over 70 µg PFAS per gram of sorbent, exceeding typical GAC utilization by an order of magnitude in several cases. No PFOS or PFOA breakthrough was observed during extended pilot durations, supporting predictable sorbent changeout intervals for full-scale design. Importantly, these pilot outcomes have directly informed near-term full-scale deployment. The first full-scale AquaPRS installation will be implemented as a rental system at a municipal utility that previously completed pilot testing. The rental unit is scheduled to enter continuous operation by March 1, 2026, and will be used to treat a defined portion of the facility’s production while the permanent PFAS treatment facility is designed and constructed. This approach allows the utility to achieve interim regulatory compliance while advancing toward a long-term capital solution. Collectively, these pilot and early full-scale transition efforts demonstrate that micro-sorbent adsorption with ceramic membrane separation provides a flexible and scalable PFAS treatment approach for municipal utilities facing diverse source waters, regulatory pressures, and implementation timelines. Ongoing full-scale operation will provide long-term performance data to further refine design guidance, confirm sorbent life projections, and support utility decision-making under evolving PFAS regulatory frameworks.