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ATTACHMENT 7 Consumer Confidence Report Certification Form (to be submitted with a copy of the CCR) APR Z 5 2016 FNVIRONMEN'FAL HEALTH PERMIT/SERVICES (to certify electronic delivery of the CCR, use the certification Form on the Division of Drinking Water's website at http://www.waterboards.ca.gov/drinking water/certlic/drinkingwater/CCR.shtml) Water System Name: Water System Number: Main well at French Well number one R.V. Park and resort The water system named above hereby certifies that its Consumer Confidence Report was distributed on 4-22-2016 (date) to customers (and appropriate notices of availability have been given). Further, the system certifies that the information contained in the report is correct and consistent with the compliance monitoring data previously submitted to the State Water Resources Control Board, Division of Drinking Water. Certified by: Name: Signature: Title: Phone Number: (209-598-2444 ) Date: 4-22-2016 To summarize report delivery used and good;faith efforts taken, please campdete the below by checking all items that apply and fill-in where appropriate: ❑ CCR was distributed by mail or other direct delivery methods. Specify other direct delivery methods used: `� "Good faith" efforts were used to reach non -bill paying consumers. Those efforts included the I \ following methods: ❑ Posting the CCR on the Intern et at www ❑ Mailing the CCR to postal patrons within the service area (attach zip codes used) ❑ Advertising the availability of the CCR in news media (att ach copy of press release) ❑ Publication of the CCR in a local newspaper of general circulation (attach a copy of the published notice, including name of newspaper and date published) Posted the CCR in public places (attach a list of locations) /❑` Delivery of multiple copies of CCR to single -billed addresses serving several persons, such as apartments, businesses, and schools ❑ Delivery to community organizations (attach a list of organ izations) ❑ Other (attach a list of other methods used) ❑ For systems serving at least 100,000 persons: Posted CCR on apublicly-accessible Internet site at the following address: www. ❑ For privately -owned utilities: Delivered the CCR to the California Public Utilities Commission This form is provided as a convenience and maybe used to meet the certification requirement of section 64483(e), California Code ofRegulations. 2013 SWS CCR Forms & Instructions Revised August 2014 CCR Certification Form — Attachment 7 Page 1 of I