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Form Bsdw 53 - Public Notification Certification Form - Tiers 1, 2 & 3 - New Jersey Department Of Environmental Protection Page 3

TCR Fecal Coliform or E. coli Notice – Template NC-4

DRINKING WATER WARNING

DO NOT DRINK THE WATER

Fecal coliform [or E. coli] bacteria were found in the water supply

on [give date].

Bottled water is available from [provide location].

Possible Health Effects

*Fecal coliforms and E. coli are bacteria whose presence indicates that the water may be

contaminated with human or animal wastes. Microbes in these wastes can cause diarrhea,

cramps, nausea, headaches, or other symptoms. They may pose a special health risk for

infants, young children, and people with severely compromised immune systems.*

People at increased risk should seek advice from their health care providers about drinking this

water.

Steps We Are Taking

[Describe corrective action.]

We will inform you when additional samples show no [fecal coliform/E. coli] bacteria and you

may drink the water. 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 [Name of Water System]. PWSID#: __________.

Date distributed:______.

Form Bsdw 53 - Public Notification Certification Form - Tiers 1, 2 & 3 - New Jersey Department Of Environmental Protection Page 3