Lead and Copper Certification Form
This is to certify that you provided the customers at your lead and copper sample sites of the results from their site.
Water System Name *
Water System Number: UTAH_______ *
example: 01234 (include any leading zeros)
Name of Owner or Operator
Position/Title
Today's Date *
MM
/
DD
/
YYYY
What Type of Water System are You? *
If you're a NTNC System You Posted Notice At:
ex: Announcement Board, Each Individual Tap
On
MM
/
DD
/
YYYY
Community Systems
Mailed/Delivered All Consumer Notices at all lead and copper sampling locations within 30 days of receiving results from the labratory?
Clear selection
Comments
If you checked No above, please give the date that you provided notice
Email
I Certify The Above Information is Correct *
Type to sign name
Submit
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