Priority Measures Plan Compliance Certification - Alaska Division Of Environmental Health
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1
2
3Division of Environmental Health
Drinking Water Program
Priority Measures Plan Compliance Certification
Instructions
1. Use this form ONLY for the following Public Water Systems (PWS):
-- Community Water Systems (CWS) serving less than 1,000 persons;
-- Non-Transient Non-Community Water Systems (NTNC) serving less than 1,000 persons;
-- Transient Water Systems (TNC) serving 1,000 persons or more.
CWS and NTNC serving 1,000 or more persons DO NOT USE THIS FORM. Use the Vulnerability Assessment
and Emergency Response Plan Compliance Certification Form.
2. Complete this form (pages 1-3) and submit it to the DEC at one of the addresses below or directly to your
Environmental Program Specialist.
3. Keep a copy of this form with your Priority Measures Plan.
Anchorage Office
Fairbanks Office
Soldotna Office
Wasilla Office
555 Cordova Street
610 University Ave.
43335 K. Beach Road, Ste. 11
1700 E. Bogard Road
Anchorage, AK 99501
Fairbanks, AK 99709-3643
Soldotna, AK 99669
Bldg. B, Suite 103
Fax: 269-7650
Fax: 451-2188
Fax: 262-2294
Wasilla, AK 99654
Fax: 376-2382
I. System Information
PWS Name
PWS Type
PWS ID#
Mailing
Address
Telephone
E-mail
Fax
Last Updated: 06/27/2017
Page 1 of 3
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