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Page 12 of 17 <br />If trcatnient was added or changed ut any way in 2015, provide a bricl'desviiption and identify the water suurce <br />TU=11rcatn ent or Distribution operator at any level <br />NR, NIA, NA—1-here are no facilities subject to the Cerlilied'PrcramenL Plant Operator rcquircmcnts <br />DIRECT ADDiTIVIs'S <br />Are all chemicals used NSPIANSI Standard 60 certified? 07 NIA (no chemicals used] v <br />INDIRECT ADDITIVES <br />As of March 9, 2008, a water system shall not use any chemical, material, lub) icant, or product iu the production, treatment or distribution o <br />drinking water that conics in contact with the drinking water that does not have certification of meeting NSFIANSI standard 61. <br />Does your water system have procedures to ensure all future equipment and materials meet this yes v <br />standard'? <br />Irynu have any questions on the requirements related to indirect additives, you may contact your local regulatory agency. <br />COAifI];L•'NTS:n <br />9. CROSS -CONNECTION CONTROL <br />No. ofInacuiw Backflow Prevention AssembiicsO7 in water system is 2015 : I I <br />I Date of last crosstamrection control survey done oil /lie system: 1 1 <br />I Cress Cnnneuiion Control Program C oordin2rlcrr <br />Nanc: <br />Certification Number: <br />littps:lldrine.ca.gov/ealIDEEarRepolt.aspx?printable=yes&SiirveyID=16&Pwsl D=CA3901... 6/6/2016 <br />Total <br />Number <br />Nuniki- <br />Number <br />Number <br />YuIrk her in <br />Installed <br />fesled in <br />Failed in <br />Repaired/ <br />System <br />in 2015 <br />2015 <br />2015 <br />Replaced <br />Backflow Assemblies DD <br />on the Service Connections or Meter <br />3 <br />0 <br />3 <br />0 <br />U <br />(Reduced Pressure Principle and <br />Double Check Valve assemblics) <br />€3ackIIow Assemblies Cin -silt but not on the Service <br />Conneclh}ns ur Melelfl <br />(Reduced Pressure principle and <br />o <br />0 <br />0 <br />U <br />U <br />Douhle Check Valve assemblies) <br />Air -gap SeparationO <br />0 <br />0 <br />No. ofInacuiw Backflow Prevention AssembiicsO7 in water system is 2015 : I I <br />I Date of last crosstamrection control survey done oil /lie system: 1 1 <br />I Cress Cnnneuiion Control Program C oordin2rlcrr <br />Nanc: <br />Certification Number: <br />littps:lldrine.ca.gov/ealIDEEarRepolt.aspx?printable=yes&SiirveyID=16&Pwsl D=CA3901... 6/6/2016 <br />