IFB 1227 Attachment 6 - Annual Water Quality Report.pdf
PDF 86 KB Posted
- Attached to
- IFB 1227 NYS Certified Water Treatment Operator for Technical Services at Industry, MacCormick, and Taberg
- Solicitation number
- 2127879
- Issued by
- Monroe County, Oneida County, Otsego County, Brookhaven CDP, New York
About this file
This is an Annual Water Quality Report Certification Form used by community water systems to certify distribution of their annual water quality reports to customers and compliance with regulatory requirements. The form requires the water system to provide its name and Public Water Supply ID number, and to be certified by a responsible official including their name, title, phone number, and date of certification. The system must confirm that the Annual Water Quality Report has been distributed to all customers and that appropriate notices of availability have been provided, and that all information in the report is accurate and consistent with compliance monitoring data previously submitted to the health department.
The form requires water systems to document their distribution methods to bill-paying customers, which may include mail delivery, hand delivery, publication in local newspapers or municipal newsletters, website posting with notification via mail or email, or other direct delivery methods. For systems serving at least 100,000 persons, the report must be posted on a publicly-accessible website in addition to direct customer delivery. The form also requires documentation of "Good Faith" efforts to reach non-bill-paying consumers through methods such as internet posting, postal mailings within the service area, news media advertising, newspaper publication, posting in public places, delivery to multi-unit addresses, and delivery to community organizations. Water systems must check all applicable distribution and outreach methods used to demonstrate compliance with public notification requirements.
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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 .