Public Notification Certification Form - Tiers 1, 2 & 3 (Page 3 of 3) in pdf

Public Notification Certification Form - Tiers 1, 2 & 3 Page 3

Unresolved Total Coliform Notice – Template NC-5

DRINKING WATER NOTICE

Tests Show Presence of Coliform Bacteria in Water

We routinely monitor for the presence of drinking water contaminants. We took [number] samples

during [month]. [Number] of those samples showed the presence of total coliform bacteria. The

standard is that no more than one sample per month may do so.

What This Means

This is not an emergency. Total coliform bacteria themselves are generally not harmful. *Coliforms

are bacteria which are naturally present in the environment and are used as an indicator that other,

potentially-harmful, bacteria may be present. Coliforms were found in more samples than allowed and

this was a warning of potential problems.*

Usually, coliforms are a sign that there could be a problem with the system’s treatment or distribution

systems.

You may drink the water. However, if you have specific health concerns, consult your doctor.

If you have a severely compromised immune system, have an infant, are pregnant, or are elderly, you

may be at increased risk and should seek advice from your health care providers about drinking this

water.

Steps We Are Taking

[Describe corrective action.]

We will inform you when additional samples show no coliform bacteria. We anticipate resolving the

problem within [estimated time frame]. For more information, please contact [name of contact] of

[name of water system] at [phone number] or [location/address].

*Please share this information with all the other people who drink this water, especially those who

may not have received this notice directly (for example, people in apartments, nursing homes,

schools, and businesses). You can do this by posting this notice in a public place or distributing

copies by hand or mail.*

This notice is being sent to you by _____________. PWSID#: _____________.

Date distributed: ______.

Public Notification Certification Form - Tiers 1, 2 & 3 Page 3