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EMERGENCY NOTIFICATION PLAN FOR SMALL WATER SYSTEMS To: Small Water System Owners/Managers Date: I propose to notify my water consumers by the following method: t I propose to notify my water consumers by the following alternate method: 1. 2. I concur with the above mentioned plan. Signature/ Title EH0336 9/94 Post warnings in a conspicuous place Shutting off all water Door to door contact Written hand outs Telephone Your Plan must include specific information regarding how an emergency water situation would be handled at your site and the procedure to be followed for notifying and protecting customers. Name of Water System <474- ^3-^^ Phone day/night z -7'53 ~ /OO^ Phone day/night reach in an emergency. • Name The California Health and Safety Code, Division 5, Part 1, Chapter 7, Article 5, Section 4029, requires all water systems to have an Emergency Notification Plan submitted to and approved by San Joaquin County Public Health Services, Environmental Health Division (Department) and updated annually. This plan is to be implemented whenever the State or Department determines that your water supply fails to meet water quality standards and represents an imminent danger to the health of the water users. An appropriate method of notifying small water system users of imminent danger from unsafe water must be used. Users must be informed that water must not be consumed until it is safe to do so. Please acknowledge methods you will use to notify your water system users in the event you must initiate your Emergency Notification Plan. Please return this form to this Department within 7 days of receipt. A? Date y 7 7 Provide names, addresses, and day/night phone numbers for two contacts this Department could ----1 ----------rgency. , . ca 3 3 a~f> E . 7 A//Ze Address W-