Seasonal Start-Up Notification Form
For questions on this form or seasonal start-up procedures please contact the Utah Division of Drinking Water at 801-536-4200 or visit us at www.drinkingwater.utah.gov

For more information on conducting your seasonal start-up please refer to the Seasonal Start-Up Procedures Checklist found the DDW Website
System Number *
System Name *
Comments on Inspection
System Disinfection *
If you disinfected what method did you use?
System Flushed *
Unidirectional Flush
Clear selection
Investigative Total Coliform Sample Collected *
Laboratory Used *
Sample Identification Number of Investigative Sampl *
Unique identifying number assigned to a sample by the labratory
Results of Sample?
Did you take your annual nitrate(s) samples? *
Please consult your monitoring schedule in WaterLink to ensure samples are\were labeled correctly.
If You Have Taken Your Nitrate(s) When? If not when do anticipate doing so*?
MM
/
DD
Projected Opening Date
MM
/
DD
/
YYYY
Your Name *
Affiliation
Position (Title)
Email Address *
Phone Number *
I Certify Under Threat of Penalty of Law That the Above Information is True and Correct *
Required
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