A copy of the public notice template will be sent to this email. This will NOT be included in the public notice template.

Enter Public Water System Identification Number.

Enter Public Water System's Name.

Select violation type stated in the letter or choose the situation that occurred. List is sorted by tier level with problem corrected at the bottom. The subject and tier level in the letter will direct you to the correct type -https://docs.google.com/document/d/1k1mAkBmbkreBs2xObT5psXqVPcabip4aHX9wQipYczo

Enter name of contact person.

Enter phone number of contact person.

Enter email address of contact person. This will be included in the public notice template.

Enter the public water system's mailing address.

What is being done resolve the issue? Include dates/time periods of violation/situation and resolution.

When will this notice be shared with the public?

When will problems be resolved?

Spanish is automatically included. If selected, the following phrase translated into the language of your choice will be included: "This report contains very important information about your drinking water. Translate it, or speak with someone who understands it."

Select if you received a failure to conduct public notice violation and need to include the statement about late notification to customers.