ccr_apdx.doc - Submit to OHA-DWS at Time of CCR Delivery or No Later than October 1 see footnote CCR CERTIFICATION FORM OHA Drinking Water Services

ccr_apdx.doc - Submit to OHA-DWS at Time of CCR Delivery or...

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CCR CERTIFICATION FORM Submit to OHA-DWS at Time of CCR Delivery or No Later than October 1 see footnote OHA Drinking Water Services Community Water System Name: PWS I.D. No: For calendar year: The community water system named above hereby confirms that its Consumer Confidence Report 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 primacy agency. CCR Certified by Name: Title: Phone No: Date CCR certified: Date CCR distributed to customers: CCR Delivery Certification: (check all items below that apply) Paper CCR was distributed by mail or other direct delivery method. Electronic delivery. Check box below and descrie how customers may request a paper copy: Notification ( mail or email-check all that apply) that CCR is available on website Specify URL (web address): CCR sent as an attachment to email (e.g. portable document format-PDF)
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  • Spring '17
  • stacy braiuca
  • Mass Media, E-mail, Water supply network, Check box, CCR

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