BOXES COLORED YELLOW ARE MANDATORY QUESTIONS AND MUST BE ANSWERED TO COMPLETE THIS REPORT
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.
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.
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.
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.
to learn how to Modify, Add and Delete Contacts in the table below.
PHONE TYPE: Home – if you use your home or personal phone number as your business number, use the HOME phone type instead and leave the BUSINESS phone type blank.
Only the BUSINESS phone type will appear in Drinking Water Watch (https://sdwis.waterboards.ca.gov/PDWW/), which can be viewed by the public, if the General Office phone number is not provided (see Water System Information section under the Intro tab).
| EXISTING CONTACTS |
| NAME, TITLE & ADDRESS | PHONE TYPE  | PHONE NO. | EMAIL | CONTACT TYPE (pick all that apply) |
| COONS, BRUCE |
Business
Home | 530-287-3427
530-287-3262 |
Brucecoons@yahoo.com
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| TREATMENT OPERATOR |
Facsimile | |
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PO Box 860
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| ALLEGHANY
CA
95910 |
Emergency | |
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| ARBOGAST, RAE BELL |
Business
Home | 530-287-3454
530-287-3454 |
raebell44@gmail.com
alleghanywater@gmail.com |
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| GENERAL MANAGER |
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PO Box 860
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CA
95910 |
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| NEW CONTACTS |
Add Additional Contact | (pick all that apply) |
| --Contact Name-- |
Business | (999) 999-9999 |
XXXXX@XXXXX.XXX
XXXXX@XXXXX.XXX |
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| --Title-- |
Home | (999) 999-9999 |
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--Address Line 1--
--Address Line 2-- |
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--ST--
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| --Contact Name-- |
Business | (999) 999-9999 |
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| --Contact Name-- |
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COMMENTS (Note: Comments will be made publicly available): |
2. POPULATION SERVED
| Population Type | Population  | Annual Operating Period  |
|---|
| Begin Date | End Date |
|---|
| MM | DD | MM | DD |
| Residential1 | 49 |
Method Used to Determine Population: |
1 |
1 |
12 |
31 |
| Transient2 | 11 | |
1 |
1 |
12 |
31 |
| Nontransient3 | 22 | |
1 |
1 |
12 |
31 |
MM = month, in 2-digit format DD = day, in 2-digit format
| If residential population is based on "Other" , identify the methods or sources of how it was estimated: |
| ACTUAL COUNT PER HOUSEHOLD |
Descriptions:
1Residential
– report the number of persons who reside within the water system service area for more than half of the year (excludes
transient and nontransient populations). If year-round, the Begin Date would be 01/01 and the End Date would be 12/31.
2Transient
– report the number of persons who are at the water system on the 60th busiest day of the year (excludes residential and nontransient
populations. Report the Begin Date and End Date if the Transient use is seasonal.
3Nontransient
– report the number of the persons who are at the water system for over 6 months per year (excludes residential and
transient populations). Report the Begin Date and End Date if the Nontransient use is seasonal.
| List the names of communities served by the system identifying both incorporated and unincorporated areas: |
| ALLEGHANY |
COMMENTS (Note: Comments will be made publicly available): |
3. NUMBER OF SERVICE CONNECTIONS (as of December 31, 2019)
A. Active Service Connections:
| Total Active Potable Water Connections currently in Division of Drinking Water database: | 57 |
The total number of Service Connections as of December 31, 2019 must be reported as either Unmetered or Metered for each Service Connection Type as appropriate.
| | Potable Water |
|---|
TYPE
Do NOT report fire sprinkler connections and fire hydrants. These connections are not counted toward “service connections” for compliance purposes. | Unmetered | Metered | Total* |
|---|
Single-family Residential: single family detached dwellings | 0 |
40 |
40 |
Multi-family Residential: Apartments, condominiums, town houses, duplexes and trailer parks | 0 |
5 |
5 |
Commercial/Institutional: Retail establishments, office buildings, laundries, schools, prisons, hospitals, dormitories, nursing homes, hotels, churches, campgrounds | 0 |
7 |
7 |
Industrial: All manufacturing | 0 |
0 |
0 |
Landscape Irrigation: Parks, play fields, cemeteries, median strips, golf courses | 0 |
4 |
4 |
Agricultural Irrigation: Irrigation of commercially-grown crops | 0 |
0 |
0 |
Total Active Connections* | 0 |
56 |
56 |
*Calculated field
If the connection categories below include some portion of residential connections, please check the boxes below:
Commercial/Institutional
Industrial
Landscape Irrigation
B. Number of Inactive Connections (all types)
Include only service connections that have been physically disconnected (e.g, meter removed) from the water system. All other service connections should be considered as “Active.” | 5 |
C. Number of NON-residential customers required to have dedicated outdoor irrigation meters (excluding agricultural connections)  | |
COMMENTS: (Note: Comments will be made publicly available) |
4. GROUNDWATER (GW) AND SURFACE WATER (SW) SOURCES
GROUNDWATER SOURCES (INCLUDING STANDBY SOURCES)
PSCode  | Name | Activity  |
| 4600012-001 | CUMBERLAND (TUNNEL) SPRING - INACTIVE | I |
| 4600012-002 | RAM SPRING | A |
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Add sources not listed above. Describe changes to sources above under "Comments".
PSCode  | Name | Activity  | Comments |
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SURFACE WATER INTAKES
PSCode  | Name | Activity  |
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Add sources not listed above. Describe changes to sources above under "Comments".
PSCode  | Name | Activity  | Comments |
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| Are your water sources metered? | |
| Do you routinely monitor the static water levels in your wells? | |
| Do you routinely monitor the pumping water levels in your wells? | |
| Are these levels recovering, declining or steady?: | |
DISCUSS CHANGES TO ABOVE SOURCES
If a STANDBY SOURCE was used in 2019, provide the following information.
Name of the Standby Source used in 2019: | No. of days the Standby Source was in operation: | Were customers notified? (Y/N) | Was DDW or Local County Staff notified? (Y/N) | Describe the reason the Standby Source was used: |
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COMMENTS (Note: Comments will be made publicly available): |
5. WATER PRODUCED, PURCHASED AND SOLD
The Maximum Day is the day during 2019 with the highest total water usage. Provide the date for that day in Column B,
then complete Columns C, D and E, indicating how much of the water on that day was from each source.
Units of Measure for the Maximum Day ONLY:
Mark this box if your water system does not have monthly production data.
If you do not have monthly production data to report, please report your Annual Total production in the row for January and leave all the other months blank.
Important Note Concerning Recycled Water Questions:
The California Water Code Section 10609(c)(4) states: “The state should identify opportunities for streamlined reporting, eliminate redundant data submissions, and incentivize open access to data collected by urban and agricultural water suppliers.”
It has come to the Division of Drinking Water’s attention that, between this Electronic Annual Report and other reports, some public water systems experience (at least some) redundant reporting of recycled water information to the Division of Drinking Water.
If some or all of the quantities are reported elsewhere, check this box: . Answer any questions below that are not reported elsewhere and leave the reported quantities blank in the table. Please note in the comments where these quantities were reported.
Leave recycled water cells blank ONLY IF it is reported elsewhere on other reports indicated below, otherwise enter zero or the actual figure.
Name of report(s) containing the information requested in this Electronic Annual Report for reporting year 2019: water usage
Regulatory entity receiving the report(s), contact name, and phone number: none
Units of Measure for tables in Section 5A except for the Maximum Day:
Volumes are based on:
Table 5A: Water Produced, Purchased, and Sold
PWS = Public Water System
*Calculated field.
Non-potable = water supplies, except recycled water, that do not enter the drinking water distribution system and are for non-potable uses only such as irrigation
Recycled = domestic wastewater which as a result of treatment is suitable for uses other than potable use such as irrigation or toilet flushing
1Only report Maximum Day if it is actually measured or determined from production records. It should not be the average day demand during
the maximum month of production.
2Do not include raw water purchased; report only volume of water that was treated.
3(F) Total Amount of Potable Water = Sum of Columns (C), (D) and (E), automatically calculated. Total water production includes water that is sold to another water system. To update, click below
6 Non-potable = water supplies, except recycled water, that do not enter the drinking water distribution system and are for non-potable uses only such as irrigation
7 Recycled = domestic wastewater which as a result of treatment is suitable for uses other than potable use such as irrigation or toilet flushing. The recycled water collected in this table should be the non-potable recycled water which is used to substitute potable water or untreated surface and well water. If the recycled were not available, potable or untreated surface and well water needs to be used. Example, a landscape used to be irrigated using potable water but now using recycled water.
4This is the percentage of the total annual volume for Groundwater produced that was provided treatment to meet drinking water standards other than precautionary disinfection and fluoridation.
5If water was Purchased/received from or Sold/delivered
to another PWS, complete the table below:
Specify whether water was Purchased or Sold or Transferred | Name of PWS |
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If recycled water was supplied to your water system’s customers
, complete the table below:
Specify the level of treatment (e.g., tertiary, disinfected secondary) | Name of Recycled Water supplier |
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COMMENTS (Note: Comments will be made publicly available): We DO have monthly totals but not daily. Do not have maximum day info. |
6. WATER RATES, AFFORDABILITY, AND FINANCES
A. WATER RATES 
Does your water system charge customers for water (residential, commercial, industrial, or institutional water customers)?
If yes, complete Section 6A. If no, explain why:
Comments (if “other” selected above):
If you do not have water rates, go to Section 6B, Deliveries.
If you have questions about completing this section of the report, please contact Mary.Yang@Waterboards.ca.gov, 916-322-6507
A1. RESIDENTIAL WATER RATES
Complete this section if you have residential water rates. If no, mark this box: and go to Section A6, Non-residential Water Rates.
If you are a water supplier without water rates, check this box , then move to Section 6B Water Deliveries.
A1.a. Indicate the type of residential water rate structure used by your water system (select those that apply): |
Base Rate – (Non-Volumetric Rates)  |
| Fixed Base Rate - Basic or fixed charge that is the same for all customers regardless of use. |
| Variable Base Rate - Basic charge is different for customers depending on size of pipe, water meter, elevation, peak use, or other factors. |
Usage Rate (Volumetric Rates)  |
| Uniform Usage Rate - The charge per 100 cubic feet of water is the same regardless of use. |
| Variable Usage Rate - Increasing Block or Tier Rate. The charge per 100 cubic feet or other increment of water increases as water use increases. |
| Other Rates |
Flat Rate (often unmetered)- One rate for providing drinking water regardless of the volume of water used, not combined with a usage rate.  |
| If you have a Flat Rate, please skip questions A1.d, A1.e, A1.g, A1.h. Enter your flat rate in A3. |
Allocation Based  |
| Other rate structure (specify your rate structure in the comment box, provide a weblink 1j below) |
A1.b. Comments on rate structure (Note: Comments will be made publicly available):
A1.h. Table on Residential Water Rates, Single-family
and Multi-family 
If your water system uses an allocation or flat base rate structure, add a direct weblink to more information on your rate structure (A1.k or A1.l), provide information in the box “Comments on Residential Rate Structure”(A1.m), and leave this table blank.
| | Provide information on residential water rates based on consumption. If a feature of your rate structure, (e.g., meter size, elevation, or other) affects water rates, provide the water rate associated with the most common situation. Enter zero “0” if not applicable. See examples |
| | Single-family Rates | Multi-family Rates |
| | Upper volume of water included in base rate in Units of Measure (UOM)
If there is no base rate or volume of water associated with a base rate, enter the number zero “0”.
| Cost per Billing Period (Dollars) | Upper volume of water included in base rate in Units of Measure (UOM)
If there is no base rate or volume of water associated with a base rate, enter the number zero “0”.
| Cost per Billing Period (Dollars) |
Base Rate (non-volumetric rates)  | |
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 (Lower level instead of higher level) The rows that follow do not include a base rate or fixed charge. Usage Rate (volumetric rates)  | Lower level of water volume for each level in UOM |
Cost per UOM (Dollars) |
Lower level of water volume for each level in UOM |
Cost per UOM (Dollars) |
| Rate Structure level 1 | |
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| Rate Structure level 3 | |
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| Rate Structure level 5 | |
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| Rate Structure level 6 | |
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A1.i. Date of most recent update to the rate structure (this does not include regularly
scheduled rate changes, rather actual changes to your rate structure): MM/DD/YYYY | |
| A1.j. Describe the rate structure changes to rate changes that were made in the update: | |
A1.k. Provide a direct link to a web page that explains water rates and fees, if available.  | |
| A1.l. If a webpage with rate information is not available, Send an email (click here) with the document, subject line: PWSID CA_ _ _ _ _ _ _ and Rate Information |
A1.m. Comments on Residential Rate Structure. Explain allocation rate, if applicable.  | |
A2. RESIDENTIAL SERVICE CONNECTIONS
| A2.a. Select the most common single-family residential meter size: | |
| A2.b. Select the most common multi-family residential meter size: | |
A2.c. What is, approximately, the service connection fee for a single-family brand-new construction based on the most common meter size listed above ($)? | 1000.00 |
A2.d. Date of most recent update to the new connection fee for a single-family brand-new construction: MM/DD/YYYY  | 4/7/2009 |
A2.e. What is the one-time fee or deposit needed to create a new water service account for an existing single-family home based on the most common meter size indicated above ($)? | 300.00 |
A2.f. What is, approximately, the connection fee for a multi-family brand-new construction based on the most common meter size indicated above ($)? | 1000.00 |
A2.g. Check items included in new residential connection fees:
A2.h. Comments on Residential Service Connections (publicly available):
A3. AFFORDABLE DRINKING WATER
For each amount of water delivered to a single-family residential customer shown below, what is charged (in dollars) to a customer?
For each of the three water volumes shown below, provide what would be the monthly water bill for a single-family residential customer. Enter the monthly Water Charges and Other Charges for each water volume. For example, if a single-family customer used 12 HCF in a month, the total bill would include water charges for using 12 HCF and other charges that are added to the bill. Other charges vary locally and may include property tax, city tax, utility users tax, services for fire suppression, waste water or sewer, stormwater or other non-water surcharges, electricity. If the “other charges” varies by certain features (e.g., by climate, lot size, landscaped area) use the lowest or most common charge in your calculation. Click the “Update Totals” button to automatically add the charges together to show a Total Monthly Water Bill that a residential customer would pay when its household used the specified amount of water.For water systems with an allocation rate (also called “budget rates”) see additional guidance 
To be consistent with California’s Human Right to Water Law and Conservation Law, the questions in this section ask for water charges associated with 6, 9, 12 and 24 hundred cubic feet (HCF) of water. Information on 9 HCF is new.
A3.a. 6 HCF  | |
| Drinking Water Charges (Fixed and variable water charges) | 40 | Dollars/month |
| Other Charges (e.g., property tax, fire suppression, waste water, other) | 0 | Dollars/month |
| Total Monthly Water Bill (Automatic sum of Water Charges and Other Charges)* | 40 | Dollars/month |
A3.b. 9 HCF   |
| Drinking Water Charges (Fixed and variable water charges) | 0 | Dollars/month |
| Other Charges (e.g., property tax, fire suppression, waste water, other) | 0 | Dollars/month |
| Total Monthly Water Bill (Automatic sum of Water Charges and Other Charges)* | 0 | Dollars/month |
A3.b. 12 HCF  | |
| Drinking Water Charges (Fixed and variable water charges) | 43 | Dollars/month |
| Other Charges (e.g., property tax, fire suppression, waste water, other) | 0 | Dollars/month |
| Total Monthly Water Bill (Automatic sum of Water Charges and Other Charges)* | 43 | Dollars/month |
A3.c. 24 HCF  | |
| Drinking Water Charges (Fixed and variable water charges) | 70 | Dollars/month |
| Other Charges (e.g., property tax, fire suppression, waste water, other) | | Dollars/month |
| Total Monthly Water Bill (Automatic sum of Water Charges and Other Charges)* | 70 | Dollars/month |
*If “Other Charges” varies, (e.g., by climate, lot size, landscaped area, or other features) use the lowest charge in your calculation.
Calculated field: To update calculated field, click button below
A3.e. Describe what is included in “Other Charges” (mark those that apply).
Property Tax
City Tax or Fee
Utility User Tax or Fee
Fire Suppression or Fire Protection Services Tax or Fee
Wastewater or Sewer Tax or Fee
Stormwater Tax or Fee
Electricity Tax or Fee
Other non-water charges and fees that are included on water bills, explain below:
Other:
A3.f. Comments on Affordable Drinking Water (publicly available):
A4. SHUT-OFFS 
Completing this section will fulfill State Water Resources Control Board requirements of Senate Bill 998 – Discontinuation of residential water service, which are mandatory as of April 1, 2020.
Click the “Update Totals” button to automatically add the Single Family and Multifamily Accounts
Community Water Systems that have water rates and more than 200 connections must complete this section. If your community water system does not meet these criteria for completing this Section, then you must mark the boxes “did not collect information” below in order to avoid completion errors.
If a water supplier tracks the number of services connections but did not collect information on whether residences were occupied or unoccupied at the time of disconnection, put the total number of disconnections in the “unknown accounts” column in the tables in this section.
If a water supplier does not differentiate between single-family or multi-family, then enter all information as single-family.
Click the “Update Totals” button to automatically sum the Single Family and Multifamily Accounts.
For section A4, select the reporting year for your answers
:
Residential Shut-offs and Reconnections
A4. This section has several questions on water services. Are you able to provide information on drinking water services alone, or are water services combined with non-water services (e.g., electricity, trash removal services) so your responses cover more than just water services?
A4.a.How many accounts for residential service connections had their water shut off once during the year due to failure to pay?
If this information is only available for accounts that had their water shut off at least once, then check this box and complete the table below and skip question A4.c
If there was no information collected for question A4.a, then mark this check box and skip below table.
| | Occupied Accounts | Unoccupied Accounts | Unknown Accounts  | Total* |
| Single-Family Accounts | 1 |
0 |
0 |
1 |
| Multi-family Accounts | 0 |
0 |
0 |
0 |
A4.b. What is the average amount owed at the time of shut-off? $ 100
Mark the box if unknown
A4.c. How many accounts for residential service connections had their water shut off more than once during the year due to failure to pay?
A4.d. What is the residential fee, including all administrative and processing fees, to restore drinking water service due to failure to pay during operating hours? 
| Single-Family Accounts | 150 |
| Multi-family Accounts | 150 |
A4.e. What is the residential fee, including all administrative and processing fees, to restore drinking water service due to failure to pay during non-operating hours? 
| Single-Family Accounts | 150 |
| Multi-Family Accounts | 150 |
A4.f. What was the median duration of the shut-offs (in days) for continuously occupied residential service accounts? 
| | Occupied Accounts | Unoccupied Accounts | Unknown Accounts  | |
If there was no information collected for question A4.f, mark the check box “Did not collect median duration of shut-offs (in days) for occupied residents" and skip below table.
| Single-Family Accounts | 2 |
2 |
0 |
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| Multi-Family Accounts | 2 |
2 |
0 |
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A 4.g How many of these shut-offs are returned to service within one-day (or 24-hours)? 2
This answer covers:
A4.h. If you offer an extended repayment or other customer payment assistance plan, how many continuously occupied residential customer accounts participated?
| Single-Family Accounts | 0 |
| Multi-family Accounts | 0 |
| Total* | 0 |
A4.i. How many of the continuously occupied residential accounts were shut off at least once during the year and were enrolled in an extended repayment plan or other customer payment assistance plan at the time of the service disconnection?
| Single-Family Accounts | 0 |
| Multi-family Accounts | 0 |
| Total* | 0 |
*Calculated field, to update calculated fields in this section, click button below
The Water Shutoff Protection Act (SB 998, 2018)
requires community water systems that have more than 200 connections to have shutoff policies completed by April 1, 2020. Mark this box if your water system has less than 200 service connections
A4.j Provide a direct weblink to your shutoff policy as required by the Water Shutoff Protection Act: https://www.alleghanywater.org/customer-service
If your water agency doesn’t have a website and for this reason is unable to post your shutoff policy, email your shutoff policy. Send an email (click here) with the document, Subject line: PWSID CA_ _ _ _ _ _ _ and Shutoff Policy
A4.k. What is the number of residential accounts (single-family, multi-family, and mixed use that include residential) that were missing one or more required water bill payments at the end of your year?
5
A4.l. For A4.k accounts, what is the sum of outstanding uncollected residential (single-family, multi-family, and mixed use that include residential) bills at the end of your most recent year?
0
Not determined
A4.m. Comments on Shut-offs (publicly available): Our shut-off policy is on the April 2020 agenda for revision. The weblink will still work. It is part of the "customer service" policy.
A5. Affordable Drinking Water Assistance
For section A5, select the reporting year for your answers
:
| A5.a. Do you provide options for low-income assistance? If you selected “No”, skip questions A5b-A5h. | |
| A5.b. If yes, how many residential accounts received the low-income subsidy? | |
| A5.c. If yes, how was the program funded? | |
| A5.d. How much funding was allocated to the program in 2019? | |
A5.e Does your program provide benefits to single-family only, or single-family and multi-family? (select answer)
A5.f. What was the average benefit amount for a single-family account in one month? 
Amount and Unit of Measure:
A5g. What was the average benefit amount for a multi-family account in one month? 
Amount and Unit of Measure:
A5.h If your system partners with an outside entity (e.g., United Way) to provide assistance to low income households, list the name of organization(s) and the amount of the benefit (in dollars) provided
Dollars provided:
Time Period:
A5.i. OTHER FORMS OF ASSISTANCE TO ALL RESIDENTIAL CUSTOMERS. What type of bill assistance was provided?
| Flexible or alterative Payment Terms |
Number of Accounts |
Average Bill $ |
| Temporary Assistance |
Number of Accounts |
Average Bill $ |
| Special Medical Need |
Number of Accounts |
Average Bill $ |
| Other Please describe: |
Number of Accounts |
Average Bill $ |
A5.j Do you have a process that can offer bill forgiveness under certain circumstance?
If yes, Number of Accounts
Average Bill $
Information Not Collected
A5.k Comments on Affordable Drinking Water Assistance (publicly available):
A6. NON-RESIDENTIAL WATER RATES 
If you have non-residential water rates, complete this section. If no, mark this box: and go to Section 6B, Deliveries
A6.a. Select the most common non-residential meter size:
A6.b. What is your billing frequency for non-residential customers?
A6. c. Does your water system use an allocation rate for non-residential accounts?
If yes, skip table A6d. In the comment box A6.e provide a weblink to more information on the allocation rates.
A6.d. Complete the table below providing specific water rates applied to your non-residential customers:
| Connection Type | BASE RATE (BR) | If BR + UUR, what is the volume allowed before UUR applies | UNIFORM USAGE RATE (UUR) | VARIABLE BASE RATE (provide range) (VBR) | VARIABLE USAGE RATE (provide range) (VUR) |
|---|
$ (Base)  | HCF  | $ per HCF | $ Low | $ High | $ per HCF Low | $ per HCF High |
| Commercial | |
|
|
|
|
|
|
| Institutional | |
|
|
|
|
|
|
| Industrial | |
|
|
|
|
|
|
| Landscape Irrigation | |
|
|
|
|
|
|
| Agricultural Irrigation | |
|
|
|
|
|
|
| Other | |
|
|
|
|
|
|
A6.e Comments on non-residential water rates (publicly available):
B. WATER DELIVERIES
Check this box if your water system does not have monthly water deliveries data and skip the rest of Section B.
Important Note Concerning Recycled Water Questions:
The California Water Code Section 10609(c)(4) states: “The state should identify opportunities for streamlined reporting, eliminate redundant data submissions, and incentivize open access to data collected by urban and agricultural water suppliers.”
It has come to the Division of Drinking Water’s attention that, between this Electronic Annual Report and other reports, some public water systems experience (at least some) redundant reporting of recycled water information to the Division of Drinking Water.
If some or all of the quantities are reported elsewhere, check this box: . Answer any questions below that are not reported elsewhere and leave the reported quantities blank in the table. Please note in the comments where these quantities were reported.
Leave recycled water cells blank ONLY IF it is reported elsewhere on other reports indicated above, otherwise enter zero or the actual figure.
Name of report(s) containing the information requested in this Electronic Annual Report for reporting year 2019:
Regulatory entity receiving the report(s), contact name, and phone number:
Units of Measure (UOM) for this table: 
Provide monthly metered water deliveries for all water sources (potable and non-potable) in the table below. If you have partially metered or unmetered water deliveries, check the help tips for additional guidance as you may be able to provide information.
Table 6B Water Deliveries
Before you begin, make sure that the water volume values entered in Section 5A Water Supplied and Section 6B Water Deliveries are consistent with each other and that they refer to the same population from Section 2 Population (“permanent population of number of long-term residents”).
PWS = Public Water System
*Calculated field
1Total Retail = Sum of Columns (B) thru (G), automatically calculated. To update, click below
2 "Other PWS" values are prefilled from the Section 5 Table, Column G
B1. Mark boxes below:
If the delivery categories below include some portion of residential deliveries, please check the boxes below:
Commercial/Institutional
Industrial
Landscape Irrigation
If you have questions about this please contact State Water Board staff by email at: waterconservation@waterboards.ca.gov. This information is being asked at this time to help staff estimate the impacts of SB 606 and AB 1668, as required for the regulatory process.
Only answer question B2 if your system is an Urban Water Supplier with dedicated outdoor irrigation meters 
B2. What is the annual volume of outdoor irrigation water used on landscape areas with dedicated irrigation meters in connection with commercial, institutional, and industrial (CII) water use?
a. Unit of Measure
b. Volume of water
c. Water system does not collect this information (mark box if applies)
Comments
B3. If known, indicate what percentage of total annual urban water deliveries (see column H in Table 6B) is used for irrigation of:
a. Developed and natural parklands
b. Publicly maintained urban trees (outside of parklands)
c. Water system does not collect this information (mark box if applies)
COMMENTS (Note: Comments will be made publicly available): |
C. FINANCIAL AND ASSET MANAGEMENT
These questions will be used by Drinking Water staff at the State Water Board to understand needs and planning for infrastructure replacement.
C1. What is the date of your most recent water system financial report? 6/30/2019
a. Provide a direct link to a web page with your most recent water system financial report, if available. https://www.alleghanywater.org/audit-reports
b. Alternatively, email your most recent water system financial report, send an email (click here) with the document, Subject line: PWSID CA_ _ _ _ _ _ _ and Shutoff Policy 
C 2 If there isn’t a water system financial report, indicate that main reason why?
If other:
Asset Management 
C 3. Do you have a water system asset management plan, water system capital improvement plan, or an equivalent plan for the replacement of major water-related infrastructure? If yes, please provide a direct weblink to your most recent infrastructure-related plan (Up to three documents may be provided)
If a webpage or weblink is not available, send an email (click here) with the document, Subject line: PWSID CA_ _ _ _ _ _ _ and Financial Documents 
C 4. Comments (publicly available):
7. WATER QUALITY

| Date of Emergency Notification Plan: | 3/20/2020 |
| Is the Emergency Notification Plan up to date? | If no is selected, please upload a revised WQENP. |
DIRECT ADDITIVES
Pursuant to Section 64590, Title 22 of the California Code of Regulations, (effective January 1, 1994), all chemicals or products, including chlorine,
added directly to the drinking water as part of a treatment process must meet the ANSI/NSF Standard 60. Please complete the following table
for each chemical used by this water system. If you are not sure whether a chemical you are using meets this standard, contact the manufacturer
or distributor of the chemical.
If you do not use any direct additives, put “NONE” in each column of the first row.
Name of Chemical | Name of Manufacturer | Purpose of using chemical | Chemical is ANSI/NSF Standard 60 certified  (Y/N) | Use initiated in 2019  (Y/N) |
| chlorine | HPH | disinfection | Y | N |
| | | | | |
| | | | | |
| | | | | |
INDIRECT ADDITIVES
As of March 9, 2008, a water system shall not use any chemical, material, lubricant, or product in the production, treatment or distribution of
drinking water that comes in contact with the drinking water that does not have certification of meeting NSF/ANSI standard 61.
| Does your water system have procedures to ensure all future equipment and materials meet this standard? | |
If you have any questions on the requirements related to indirect additives, you may contact your local regulatory agency.
COMMENTS (Note: Comments will be made publicly available): |
8. WATER TREATMENT
| Treatment Plant Name | Treatment Process | Contaminant Removed |
| | | |
| | | |
| | | |
| | | |
If treatment was added or changed in any way in 2019, provide a brief description and identify the water source
COMMENTS (Note: Comments will be made publicly available): |
9. CROSS-CONNECTION CONTROL
| Total Number in System in 2019 ¹ | Number Installed in 2019 | Number Tested in 2019 ² | Number Failed in 2019 | Number Repaired/ Replaced |
|---|
Backflow Assemblies  on the Service Connections or Meter (Reduced Pressure Principle and Double Check Valve assemblies) | 0 |
0 |
0 |
0 |
0 |
Backflow Assemblies On-site but not on the Service Connections or Meter (Reduced Pressure Principle and Double Check Valve assemblies) | 4 |
4 |
0 |
0 |
0 |
Air-gap Separation | 1 |
1 | | | |
Notes:
¹ Total Number in System in 2019 – Total number of active Backflow Prevention Assemblies including new devices installed in 2019, but excluding inactive devices.
² Number Tested in 2019 – includes all active devices that were tested in 2019 and either passed or failed.
No. of Inactive Backflow Prevention Assemblies in water system in 2019 : | 0 |
| Date of last cross-connection control survey done on the system: | 7/1/2014 |
|
| Cross Connection Control Program Coordinator |
| Name: | |
| Certification Number: | |
| Business Phone: | |
Email Address: | |
| Certification or training received: |
Describe any cross-connection incidents
that occurred during 2019:
COMMENTS (Note: Comments will be made publicly available): |
10. OPERATOR CERTIFICATION 
A. Please list the State certified Water Treatment Plant Operators employed by your water system that supervise and direct the operation
of your water treatment plants, beginning with the chief operator(s)
.
Your Highest Treatment System Classification is: There are no facilities subject to the Certified Treatment Plant Operator requirements
If you do not have a Certified Treatment System Operator, put "NONE" in each column of the first row.
Check this box if your public water system has designated a Chief Treatment Operator.
| Name of Chief Treatment Operator (First name Last name): | |
| Grade of Chief Treatment Operator (1, 2, 3, 4 or 5): | |
| Treatment Operator Number (4 or 5 digits): | |
| Treatment Certification Expiration Date (MM/DD/YYYY): | |
Treatment Operator Name (First name Last name) | Grade of Treatment Operator (1, 2, 3, 4, or 5) | Chief or Shift1 (C, S or X) | Treatment Operator Number (4 or 5 digits) | Treatment Certification Expiration Date (MM/DD/YYYY) |
| none | none | none | none | 00/00/0000 |
| | | | | |
| | | | | |
| | | | | |
1Use “C” for Chief Operator and “S” for Shift Operator. If neither, put an "X". Do not leave blank.
Do your Chief and Shift Treatment Plant Operators have the minimum level required?
B. Please list the State certified Water Distribution System Operators employed by your water system that supervise and direct the operation
of your distribution systems, beginning with the chief operator(s)
.
Your Distribution System Classification is: D1
If you do not have a Certified Distribution System Operator, put "NONE" in each column of the first row.
Check this box if your public water system has designated a Chief Distribution Operator.
| Name of Chief Distribution Operator (First name Last name): | |
| Grade of Chief Distribution Operator (1, 2, 3, 4 or 5): | |
| Distribution Operator Number (4 or 5 digits):
| |
| Distribution Certification Expiration Date (MM/DD/YYYY): | |
Distribution Operator Name (First name Last name) | Grade of Distribution Operator (1, 2, 3, 4, or 5) | Chief or Shift1 (C, S or X) | Distribution Operator Number (4 or 5 digits) | Distribution Certification Expiration Date (MM/DD/YYYY) |
| Bruce Coons | 1 | c | 31959 | 1/1/2022 |
| Edward Snyder | 1 | s | 49333 | 11/1/2020 |
| | | | | |
| | | | | |
1Use “C” for Chief Operator and “S” for Shift Operator. If neither, put an "X". Do not leave blank.
Do your Chief and Shift Distribution System Operators have the minimum level required?
COMMENTS (Note: Comments will be made publicly available): |
11. WATER SYSTEM IMPROVEMENTS
The California Waterworks Standards (Section 64556) require an amended permit for any of the following improvements or modifications:
- Addition of a new distribution reservoir with a capacity of 100,000 gallons or more
- Modification or extension of the existing distribution system using an alternative to the requirements of the California Waterworks Standards
(see Sections 64570 through 64578) - Modification of the water supply by:
- Adding a new source
- Changing the status of an existing source (for example, active to standby) or
- Changing or altering a source, such that the quality or quantity of water supply could be affected
- Any addition or change in treatment, including
- Expansion of the existing service area by 20 percent or more of the number of service connections specified in your current permit.
If your water system made any improvements or modifications during 2019 for which a permit was not obtained, please describe the improvements
or modifications below.
Indicate any planned improvements or modifications for 2020.
COMMENTS (Note: Comments will be made publicly available): |
12. COMPLAINTS REPORTED (WRITTEN OR VERBAL)
| Type of Complaint | No. of Complaints Reported by Customers | No. of Complaints Investigated | No. of Complaints reported to the Division of Drinking Water or Local County Staff | Brief Description of Cause and Corrective Action taken |
|---|
| Taste and Odor | 6 |
6 |
2 |
bad taste, turned out to be corroding bolts inside new tank. |
| Color | |
|
|
|
| Turbidity | |
|
|
|
| Visible Organisms | |
|
|
|
| Pressure (High or Low) | |
|
|
|
| Water Outages | |
|
|
|
Illnesses (Waterborne) | |
|
|
|
| Other (Specify) | |
|
|
|
Total No. of Complaints* | 6 |
6 |
2 | |
*Calculated field
COMMENTS (Note: Comments will be made publicly available): Bolt replacement will be scheduled when the weather allows. Problem reported to the State Division of Drinking water when it was found. |
13. SYSTEM PROBLEMS
| Type of Problem | No. of Problems | No. of Problems Investigated | No. of Problems Reported to the Division of
Drinking Water
or Local
County Staff | Brief Description of Cause and Corrective Action Taken |
|---|
Service Connection Breaks/ Leaks | 1 |
1 |
0 |
broken water line at meter box fixed |
| Main Breaks/Leaks | 0 |
0 |
0 |
|
Water Outages | 0 |
0 |
0 |
|
| Boil Water Orders | 0 |
0 |
0 |
|
| Total* | 1 |
1 |
0 | |
INFRASTRUCTURE AND PRESSURE 
Pipe Material in Distribution System
1. Which materials does your distribution system pipe consist of? Please check all that apply:
Plastic (Including Poly Vinyl Chloride and HDPE)
Steel
Cast Iron
Galvanized Iron
Ductile Iron
Cement Concrete
Asbestos Cement
| Pipeline Material | Percentage of distribution pipe system composed of the materials selected above | Average Age (in years) |
| Plastic | 10 |
|
| Steel | |
|
| Cast Iron | |
|
| Galvanized Iron | |
|
| Ductile Iron | |
|
| Cement Concrete | 90 |
|
| Asbestos Cement | |
|
| other: |
|
|
COMMENTS (Note: Comments will be made publicly available): |
14. EMERGENCY PREPAREDNESS & RESPONSE, AND WATER PARTNERSHIPS
A. EMERGENCY RESPONSE PLANS
PUBLIC WATER SYSTEMS WITH AT LEAST 3,300 OR MORE PERSONS SHOULD REVIEW AND REVISE THEIR EMERGENCY
RESPONSE PLAN TO ENSURE THAT THE PLANS ARE SUFFICIENT TO ADDRESS POSSIBLE DISASTER SCENARIOS.
Do you have an Emergency Response Plan (ERP) that addresses the procedures for the restoration of water service for your water system? | |
| Date of your current Emergency Response Plan: | |
| Date ERP was last exercised with a tabletop or other activity: | |
Are you registered in your local energy utility’s Public Safety Power Shutoff notification plan?
B. AUXILIARY POWER SUPPLY
| Does your water system have backup power for: |
1. Sources: | |
| 2. Pumping Stations: | |
| 3. Water Treatment Plants: | |
| If your system has backup power, how many times per year is it exercised? | 12 |
| Can your system maintain system pressure in all pressure zones either by backup power or by gravity fed storage
during power outages for each of the following number of hours? |
| 24 hours |
| 48 hours |
| 72 hours |
| Is your backup power system automatic or manual start?: | |
C. WATER PARTNERSHIPS
1) Are you interested in obtaining information about water partnership or consolidation options?
If yes, please mark those that apply:
Please have Drinking Water staff contact our organization with more information about water partnership activities such as consolidation, extension of service, or interties that connect one system to another
Please send my water system information about training opportunities
Please send my water system information about funding options for water partnerships and consolidations
COMMENTS (Note: Comments will be made publicly available): |
15. WATER CONSERVATION AND DROUGHT PREPAREDNESS
| 1. Date of your revised Drought Preparedness Plan or Water Shortage Contingency Plan, if any: | 6/28/2016 |
| Water system does not have a current drought or water shortage plan, mark box if applies: | |
| 2. Did your water system experience water shortages in 2019? | |
| If yes, please estimate the amount of shortfall in units selected for this section | Volume of water: |
| Units of Measure: |
3. How many water-shortage response stages are in your drought plan? For “non-applicable”, enter zero.  | |
| 4. Did drought conditions cause you to activate emergency standby wells in 2019? | |
5. Do you project water shortages in the current calendar year?  | |
6. Does your water system anticipate having to go to mandatory restrictions in the upcoming year?  | |
7. Identify the method your water system uses to discourage excessive water use when in drought, in support of SB 814 (2016)
(Check as applicable)
7e. COMMENTS REGARDING SB 814 (Note: Comments will be made publicly available) :
8. To identify data streamlining opportunities, are there other government agencies, aside from the Department of Water Resources, that require reports on the same information found in the Electronic Annual Report? If yes, please describe (include the title of the report, which agency receives it, and the type of information it includes):
9. COMMENTS (Note: Comments will be made publicly available): |
16. CLIMATE CHANGE ADAPTATION AND RESILIENCY FOR WATER UTILITIES
Per Waterboard Resolution 2017-0012, dated 3/7/17, water system inspections are required to address climate change impacts & concerns.
ONLY FOR COMMUNITY WATER SYSTEMS
Your water system classification is: Community Water System 
If you have questions about completing this section of the report, please contact Joseph.Crisologo@waterboards.ca.gov or call (818) 551-2046.
| A. CLIMATE THREATS |
What climate-related impacts are of concern for your water system (check all that apply)?  |
| B. SENSITIVITY AND MAGNITUDE OF IMPACTS |
Qualitatively assess climate change sensitivity of your facilities, and criticality or consequence of disruption. Consider identified climate threats using past experience, and expert judgement based on the magnitude of expected change and extreme events in the future. You do not need numeric answers. USEPA provides a risk assessment tool, called CREAT, to help utilities identify which environmental changes can impact water supply: https://www.epa.gov/crwu/build-resilience-your-utility. More resources are available that may help you complete this section.  |
| Drought | Groundwater Depletion | Decreased water storage (low lake and reservoir levels) | Choose an item |
| Groundwater depletion (increased extraction, reduced groundwater recharge, etc.) | Choose an item |
| Change in seasonal runoff and/or loss of snowmelt | Choose an item |
Region relies on water diverted from the Delta, imported from the Colorado River, or other climate-sensitive area | Choose an item |
| Water Quality Degradation | Salt-water intrusion into aquifers | Choose an item |
| Altered water quality during storm events (turbidity shifts, debris flows) | Choose an item |
| Surface water quality issues related to eutrophication, algal blooms, invasive species | Choose an item |
| Flooding | Sea Level Rise | High flow events and flooding | Choose an item |
| Inundation due to sea level rise, high tides, and/or coastal storm surges | Choose an item |
| Aging flood protection infrastructure (levees), or insufficient impoundment capacity | Choose an item |
| Extreme Heat | Peak demand volume surges (due to extreme heat, temperature trends, etc.) | Choose an item |
| Increases in agricultural water demand or energy sector needs | Choose an item |
| Fire | Other Impacts | Increased fire risk and altered vegetation, e.g., wildfires | Choose an item |
| Disruption of power supply | Choose an item |
| Other |
Choose an item |
| C. ADAPTATION MEASURES |
Identify measures to increase resiliency and reduce vulnerabilities based on identified water system sensitivities. Indicate status for all projects that your organization has completed or plans to implement to increase resiliency of the water system to climate change? Adaptation measures planned or achieved for reasons other than climate change should be put in the “Other” box along with the reason for the measure. USEPA’s Adaptation Strategies Guide for Water Utilities provides examples of adaptation: https://www.epa.gov/crwu/learn-how-plan-extreme-weather-events  |
| Install new and deeper drinking water wells, or modify existing wells to increase pumping capacity | Choose an item |
| Develop local supplemental water supply, enhanced treatment, or increased storage capacity (e.g. recycled water, storm runoff for groundwater recharge, desalination, new reservoir) | Choose an item |
| Interconnection with other utilities (transfers, mutual aid agreements with neighboring utilities) | Choose an item |
| Relocate facilities, construct or install redundant facilities | Choose an item |
| Modify facilities (e.g., install barrier or levee, raise a wall, seal a door, elevate construction) | Choose an item |
| Conservation measures (demand management, enhanced communication and outreach) | Choose an item |
| Fire prevention – brush management, partnerships | Choose an item |
| Alternative or backup energy supply | Choose an item |
| On-site energy generation | Choose an item |
| Enhance monitoring program, budget for additional testing and treatment, chemicals | Choose an item |
| Other |
Choose an item |
COMMENTS (Note: Comments will be made publicly available): |
17. LEAD SERVICE LINE REPLACEMENT

ONLY FOR COMMUNITY WATER SYSTEMS
Your water system classification is: Community Water System
Section 116885 of the California Health and Safety Code, Lead Service Lines in Public Water Systems, added to the Health and Safety Code by Senate Bill 1398 (2016) and amended by Senate Bill 427 (2017), requires all community water systems (CWSs) to compile an inventory of known partial or total lead user service lines in use in its distribution system by July 1, 2018. DDW is utilizing the electronic annual report (eAR) to gather and update this information.
CWSs that reported in the table below the existence of lead user service lines (A) or unknown material user service lines (B) or lead/unknown fittings associated with user service lines (M or O), need to submit to a timeline for replacement of those user service lines or fittings to DDW by July 1, 2020. Please include the updated information on your user service line inventory below so DDW can track the progress of your system. If you have identified user service lines in A, B, M or O below, you will need to upload a timeline, including a spreadsheet listing the locations and replacement schedules and a letter or short report contain the justification for the dates of the replacement, for approval by DDW. Please utilize the spreadsheet template located on DDW’s lead service line webpage to document the replacement schedules. For the suggested contents of the letter or report, please check the Fact Sheet on DDW’s lead service line webpage. Water systems that previously reported service lines of unknown materials, that have now identified those materials and can certify that no lead or unknown service lines exist, must upload a certification form under the LSLR tab in place of a timeline report or letter.
For additional information including the spreadsheet template, certification form and Facts Sheet, please visit
https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/lead_service_line_inventory_pws.html
If you have questions about completing this section of the report, please contact David.Pimentel@Waterboards.ca.gov or call (916) 323-0572.
IMPORTANT: In the 2017 and 2018 electronic Annual Reports, all CWSs were required to submit the lead service line inventory to the DDW. The inventory will be prefilled with the 2018 EAR data for this section. Please review the table below and take this opportunity to make changes and update your inventory. Do not leave entry spaces blank. You must enter zero in any yellow fields which are not populated, otherwise errors will be generated at the end of the eAR report.
If your water system is a wholesaler and contains no user service lines, you are not required to complete this form: Please check this box:
| Date lead service line inventory was completed (MM/DD/YYYY): | 09/11/2018 |
A. User service line inventory:
"User service line" means the pipe, tubing, and fittings connecting a water main to an individual water meter or service connection.
| Pipe Material | Estimated Number of Service Lines (Enter “0” if none) | Estimated Total Length of Service Lines (In feet), if applicable |
|---|
| A. Lead | 0 |
|
| B. Unknown material | 0 |
|
| C. Copper | 0 |
| D. Cast iron (ductile pipe) | 0 |
| E. Ductile iron | 0 |
| F. Galvanized steel | 0 |
| G. Polyvinyl chloride (PVC) | 4 |
| H. Polyethylene (PE) | 0 |
| I. High density polyethylene (HDPE) | 0 |
| J. Polybutylene (PB) | 0 |
| K. Transite/asbestos cement | 53 |
| L. Other materials not listed above: | |
| Identify material 1 | |
0 |
| Identify material 2 | |
0 |
| Identify material 3 | |
0 |
| Identify material 4 | |
0 |
| Total number of service lines inventoried* (calculated field) | 57 |
| Total number of service connections from Section 3 of the EAR | 57 |
Fittings or fittings connecting a water main: | | | M. Lead fittings NOT on a lead pipe(e.g., goosenecks, pigtails, and corporation stops) | 0 |
| N. Lead fittings ON a lead pipe (e.g., goosenecks, pigtails, and corporation stops) | 0 |
| O. Fittings of unknown material (e.g., goosenecks, pigtails, and corporation stops) | 0 |
| Total number of lead service lines** (calculated field) | 0 |
*Total number of service lines inventoried (calculated field) = Sum of A through L
**Total number of lead service lines (calculated field) = Sum of A and M
To Update calculated field, click button below
B. Method(s) used to prepare the lead service line inventory in Part A (check all that apply):
Tap Cards or tickets from initial service installation
Plans from water main installation, rehabilitation, and replacement
Records indicating when buildings were constructed
Meter replacement records
Distribution maps, drawings, or GIS
Visual confirmation of pipe material by plumbers or utility crews during maintenance or installation activities
Interviews with water system personnel and/or past employees
Field investigations
Other (describe below):
C. COMPLIANCE WITH LEAD SERVICE LINE REPLACEMENT REQUIREMENT - NEW
Select one of the following options which applies to all community water system:
-
If the CWS completed the requirement by reporting no lead or no unknown service lines or fittings in the 2017, 2018, and 2019 EAR (2017, 2018, and 2019 EAR LSLR inventory table in subsection A. have rows A, B, M and O equal to 0), Check the box below to indicate you have completed the requirement. Click OK in the two pop-up windows that open after the box is checked. No further action is required.
No lead and no unknown material service lines or fittings.
-
If the CWS reported lead or unknown material service lines or fittings in the 2017 and/or 2018 EAR LSLR section AND have since replaced or identified the materials (2019 EAR LSLR inventory table in subsection A. has rows A, B, M and O equal to 0), complete the LSLR certification form (the template can be found at the webpage linked below) then click HERE to upload the completed form. When you click on the HERE link, a new browser tab will open to the Replacement Timeline LTR or Certification Form upload page, after you have uploaded the document navigate back to this browser tab to complete the Finalize section of the EAR.
The LSLR certification form template and FAQs can be found on the Lead Service Line Inventory Requirement for Public Water Systems webpage in the Resource and supplemental material section (bottom of page) at: https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/lead_service_line_inventory_pws.html
-
If the CWS reported lead or unknown material service lines or fittings in the 2019 EAR LSLR section (rows A, B, M and/or O are NOT equal to 0), a Replacement Timeline letter and spreadsheet must be submitted. The completed letter and spreadsheet (Replacement Timeline LTR and SS) should be uploaded at the links provided in 3.a. and 3.b. When you click on the HERE link below in 3.a., a new browser tab will open which has the Replacement Timeline LTR upload location, after you have uploaded the document navigate back this browser tab and click the HERE link in 3.b. for a new browser tab to open with the upload page for the Replacement Timeline SS. You will need to return to this browser tab to complete the Finalize section of the EAR after the uploads are completed.
- Click HERE to upload the Replacement Timeline LTR
- Click HERE to upload the Replacement Timeline SS
The timeline spreadsheet template and FAQs on this requirement can be found on the Lead Service Line Inventory Requirement for Public Water Systems webpage in the Resource and supplemental material section (bottom of page) at: https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/lead_service_line_inventory_pws.html
If you are not able to upload the Replacement Timeline documents before the 2019 EAR is due, submit the 2019 EAR report on or before the report due date. After the EAR is reviewed, District or LPA Staff will return the EAR for revisions to allow you to upload the required documents by the July 1, 2020 deadline. You can request your District or LPA Office return the EAR for revision if you are ready to upload the documents before the review is completed.
Please indicate the total number of hours spent to complete this report. This information will be utilized to characterize the level of effort required to complete this report 3
By checking this box you acknowledge that any information submitted in this report is publicly accessible and may be used by the State of California to determine compliance with applicable laws and regulations. Knowingly submitting false information in this report is a misdemeanor, and by submitting this information you certify that the contents are, to the best of your knowledge, complete and correct.