Chlorination Notification Form

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Chlorination Notification Form

Please submit this form at least 2 weeks before the chlorination process.

If you have any questions, please contact Anh Tran in SDSU Environmental Health and Safety at anh.tran@sdsu.edu or 619-594-1858.

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* Indicates required question

Project Representative Information

Company Name *

Your answer

Name and Title of Project Representative *

Your answer

Email Address of Project Representative *

Your answer

Phone Number of Project Representative *

Your answer

Water Line(s)/System(s) to be Chlorinated (include length and size) *

Your answer

Was the system initially flushed? *

Yes

No

Did the system pass the pressure test? *

Yes

No

N/A (domestic system only)

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