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Page 13 of 17 <br />Business Phone: <br />Cerlificalian or training tt:mived; <br />Descr•ihe any cuss -connection incidents (D that occurred during 2015: <br />C0-41h1VN*I'S:(D <br />Finail Address: <br />10. CONSUMIsR CONFIDENCE REPORT Q (dues not aly)ly io 7'r•nnslenl Non vinmunily Ivarer s),slemsj <br />THIS, 2015 CCR MUST BE DISTRIBUTED TO FOUR CUSTOAlERS ANY) A COPY SUBMITTED TO YOUR LOCAL RECULATORY <br />AGENCY 11Y ,IDLY 1, 2016. IN ADDITION, PUBi.IC WATER SVST E MS THAT ARE ALSO REGULATED BY THE CALIFORNIA, PUBLIC <br />UTILITIES COMMISSION (PUC) NJ LIST NAII, A COPY OF'1'11EIR CCR 1'0 THE PUC RY .11) LY 1, 2016. <br />CERTITICXHON N11191' BE St)BMrrI'ED TO YOUR LOCAL REGULATORY AGENCY BY OCTOBER 1, 2016, STATING THAT THE <br />2015 CCR 11AS BEEN DISTRIBUTED <br />TO CUSTOMERS AND THAT THE INFORA XFION IS CORK-K`T. <br />The CCR guidance, CCR template, and the ccrtilicaiion name can he obtained from tate Divisiort of Drinking Wale web site <br />at'ht4sll«�vw.tvaterbnarde,ca.gnvldrinking water/ceriliciddrIkin�vater/CCR.shunl <br />indicate the date your 2015 CCR Was distributed or will be distributed to your customers: 7/112016 mmrdevyyyy <br />COrMNI F:NT.13:0 <br />11. OPERATOR CERTIFICATION <br />A. Pleas: list the State certified Water Treatment Plant Operntors employed by your water system that supervise and direct tke operation <br />oryutu, water treatment plants, beginning whit the chief operalor(s) D. <br />Your IligAest Tmalntenl System Classification is: There are no facilities subject to the Cerlified'I'realmenl Plant Operator rceluir•cmcnts <br />Iryou cin not have a Cer4ified Treatment Opermtor, put "NON17 in each column of the first row. <br />iVa[t[e <br />Grade of <br />Operntor <br />Chief nr <br />Shift' (C1S) <br />Operutur <br />Number <br />Expiration !late <br />act <br />na <br />Ila <br />Ila <br />as <br />'Use "C'for Chief Operutur and "S" Cor Shift Operator. Ifneithcr, put an X'. <br />Do your Cltief and Shi11 1'realment Plant Opmuors have the miniInuin IcvcI required? INo treatment facility except precautionary disintectlon <br />R. Please IIsi Ilse State certflcil Water Distribution Opet:ntm's employed by your water system that supervise and direct lire Ulceration <br />of your distribution systems, beginning Willi the chief upera[or(s) M. <br />littps:lldriiie.ca.gov/cat•/DEEarIteport.aspx?printable=yes&SulveyID=16&Pws1I]=CA3901.., 6/6/2016 <br />