SMALL WATER SYSTEM
2018 ANNUAL REPORT TO THE DRINKING WATER PROGRAM
FOR YEAR ENDING DECEMBER 31, 2018
[Section 116530 Health & Safety Code]
BOXES COLORED YELLOW ARE MANDATORY QUESTIONS AND MUST BE ANSWERED TO COMPLETE THIS REPORT Water System Ownership Descriptions:- Local Government: e.g., city, county, or special district, local school district, junior colleges, county or community parks, etc.
- State or Federal Government: e.g., state or national park, BLM, USFS and COE campgrounds and recreation facilities,
state hospitals, State universities and colleges, California Veterans Home, County or District Fairs and Expositions,
Caltrans rest stop, military base, other state or federal facility - Privately owned, non-PUC-regulated (Community Water System): e.g., mobile home park, apartment or condominium
- Privately owned business (non-community): e.g., church, private school, restaurant, amusement park, RV park/campground,
motel, ranch/farm, factory, other business establishment
COMMUNITY WATER SYSTEMS WHO RECEIVE AN ANNUAL BILL FROM THE STATEIF YOU RECEIVE AN ANNUAL BILL FROM A LOCAL COUNTY, SKIP THIS SECTION.
Your water system classification is: IF YOU ARE NOT A COMMUNITY WATER SYSTEM, SKIP THIS SECTION.
CERTIFICATION FOR REDUCTION OF ANNUAL FEES FOR PUBLIC WATER SYSTEMS SERVING A DISADVANTAGED COMMUNITY (DAC)  If you are a community water system who has previously submitted documentation to the State Water Resource Control Board certifying that you are serving a DAC, you must check the box below to continue receiving a reduced annual fee. I certify under penalty of perjury under the laws of the State of California as a duly authorized representative of the public water system for which this document is being submitted that the foregoing is true and correct: the public water system for which this report is being submitted served a disadvantaged community (as defined in Title 22, Division 4, Chapter 14.5, section 64300 of the California Code of Regulations) for the year in which this report is applicable, and, if requested to do so by the State Board, will provide documentation to the State Board upon request, which may include an income survey, that the public water system served a disadvantaged community during the time period for which this report applies. If you are a community water system who is not currently receiving a DAC fee reduction, is a serving a DAC as defined in Title 22, Division 4, Chapter 14.5, section 64300 of the California Code of Regulations and would like to request a fee reduction, you must complete DAC certification form and upload the form to the “DAC” tab for the State Water Resources Control Board to review your request.
Click HERE for instructions on how to upload your completed DAC certification form. To upload a DAC Certification Form, click HERE If you have questions about completing this section of the report, please contact the Program Liaison Unit at DDW-PLU@waterboards.ca.gov or call (916) 449-5158.
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Please be aware that all comment boxes throughout this electronic annual report will be made publicly available WITH THE EXCEPTION of the comment box below. Only Waterboard staff and other people with your water system’s DRINC login credentials will have access to this comment box. You are encouraged to provide any comments that you believe may help improve this annual report process.
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