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3930FMBSDW0061Rev. 6/2025 COMMONWEALTH OF PENNSYLVANA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF SAFE DRINKING WATERLABORATORY NOTIFICATION FORM FOR DRINKING WATER RESULTS (Please Print Clearly)This
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How to fill out public water system notification

01
Start with the header, including the name of the water system and date of notification.
02
Identify the reason for the notification, such as a water quality issue or changes in service.
03
Provide a detailed description of the situation affecting the public water supply.
04
Include any measures being taken to resolve the issue.
05
Specify the timeframe for the notification validity.
06
Add contact information for further inquiries or concerns.
07
Conclude with instructions for consumers, if necessary.

Who needs public water system notification?

01
Residents and businesses using the public water supply.
02
Local health departments responsible for public health safety.
03
Regulatory agencies that oversee water quality standards.
04
Community organizations monitoring environmental impacts.
05
Emergency response teams during a water quality crisis.
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Public water system notification is a regulatory requirement that informs the public about the quality of drinking water, potential contamination, and any necessary actions that users must take to ensure their safety.
Public water system notification must be filed by operators of public water systems, including municipalities, water utility companies, and other entities that supply drinking water to the public.
To fill out a public water system notification, operators must provide specific information such as system identification, water quality test results, any violations of water quality standards, and corrective actions taken, as well as the contact details for further inquiries.
The purpose of public water system notification is to ensure transparency and public awareness regarding drinking water quality, to mitigate health risks, and to inform consumers about any necessary steps to take in case of potential contamination.
Information that must be reported includes water quality test results, any violations of water quality standards, the nature of contaminants, health risks associated with the contaminants, and measures taken to address issues, as well as how consumers can obtain further information.
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