IFB 1185 Attachment 6 - Annual Water Quality Report.pdf
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- Solicitation number
- 2122756
About this file
This document is an Annual Water Quality Report Certification Form, which appears to be a standard compliance document for a community water system. The form requires the water system to confirm that its Annual Water Quality Report (AWQR) has been distributed to customers and that the information contained in the report is correct and consistent with previously submitted compliance monitoring data. The form provides multiple options for distributing the water quality report, including mail, direct delivery, electronic methods such as email and website posting, and publication in local media.
The certification form includes sections for the water system to document how they distributed the report to bill-paying customers, including options like mailing, hand delivery, publication in local papers or newsletters, and various electronic delivery methods. Additionally, the form requires water systems to indicate "Good Faith" efforts to reach non-bill paying consumers, such as posting the report on the internet, mailing to postal patrons, advertising in news media, publishing in local newspapers, posting in public places, and delivering multiple copies to apartments, businesses, and community organizations. The form is designed to ensure transparency and accessibility of water quality information to all consumers served by the water system.
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Text version
Annual Water Quality Report Certification Form
Water System Name: ___________________________ _
Public Water Supply ID#: _______________________ _
The community water system named above hereby confirms that its Annual Water Quality Report (AWQR) has been distributed to customers and appropriate notices of availability have been given. Further, the system certifies that the information contained in the report is correct and consistent with the compliance monitoring data previously submitted to the health department.
Certified by: Name:
Title:
Phone#: Date:
Please indicate how your report was distributed to your customers:
D AWQR was distributed to bill-paying customers by mail.
D AWQR was distributed by other direct delivery method(s) (check all that apply)
D Hand delivered.
D Published in local paper (i.e., Penny Saver) that was directly delivered or mailed to all bill-paying customers.
D Published in local municipal newsletter that was directly delivered or mailed.
D Mailed a notification that AWQR is available on a public website via a direct URL
D Emailed with a message containing a direct URL link to the A WQR
D Emailed with A WQR sent as an attachment to the email
D Emailed with AWQR sent as an embedded im�ge in the email
D Additional electronic delivery that meets "otherwise directly deliver" requirement
D Other (please specify) _______________________ _ D System does not have bill-paying customers.
D For systems serving at least 100,000 persons: in addition to direct delivery to bill-paying customer the AWQR was posted on a publicly-accessible website at www. ____________ _
Please indicate what "Good Faith" efforts were used to reach non-bill paying consumers ( check all that apply).
D Posting the Annual Water Quality Report on the Internet at www. _________ _
D Mailing the Annual Water Quality Report to postal patrons within the service area
D Advertising the availability of the Annual Water Quality Report in the news media
D Publication of the Annual Water Quality Report in a local newspaper
D Posting the Annual Water Quality Report in public places (attach a list oflocations)
D Delivery of multiple copies to single-bill addresses serving several persons such as: apartments, businesses, and large private employers
D Delivery to community organizations
Other (please specify) _________________________ _ it3012 Rectangle it3012 Rectangle
File details come from the government source that posted it. Updated .