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Reporting Forms

Annual Pumpage/Usage Reporting Form in Microsoft Word or Adobe Acrobat
Community water supplies that do not submit a monthly operation report must submit a report of annual water pumpage and use to the DEQ district office by March 31 of each year.

Cross Connection Reporting Form in Microsoft Word or Adobe Acrobat
Community water supplies must report annually on the status of their cross connection program to the DEQ district office by March 31 of each year.

Bacteriological Sample Siting Plan in Microsoft Word or Adobe Acrobat
Water supplies must have a current sample siting plan detailing sampling locations for routine and follow-up
bacteriological monitoring.

Lead and Copper Report and Consumer Notice of Lead Result in Microsoft Word or Adobe Acrobat
This form supersedes two older forms, the Lead and Copper Reporting Form and the Consumer Notice of Lead Results Certificate.  Water supplies must report lead and copper monitoring information to the DEQ district office within 10 days after the end of the lead and copper monitoring period.  Additionally, water supplies must provide a notice of the individual tap result from lead tap water monitoring to occupants of the home or building tested within 30 days of knowing the result.  A water supply may use the suggested format provided in this form.  The water supply must certify that the requirement was met and send the certification along with a sample of the notice to the DEQ district office.  Water supplies may use the certificate provided in this form.

CCR Certification Form in Microsoft Word or Adobe Acrobat
Community water supplies must submit a certificate to the DEQ district office immediately following delivery of the annual Consumer Confidence Report confirming that the CCR is correct and has been distributed as required.

DEQ districts serving Community Water Supplies

Addresses of the 8 DEQ district offices overseeing community water supplies and the counties they serve.

DEQ district map with telephone numbers of DEQ staff that oversee the community water supply program and the counties they serve.

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Related Content
 •  10 States Standards
 •  Suggested Practices for Water Works PDF icon
 •  Cross Connection Brochure PDF icon
 •  Fluoridation Information
 •  Water Supply Permit Application & Streamlined Checklist
 •  *NEW* Cross Connection Rules Manual - Fourth Edition PDF icon

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