The Emergency Notification Plan Form for Small Water Systems is the Sacramento County Environmental Management Department (EMD) form on which a small water system lists the people who will carry out its plan and the methods it will use to warn water users of unsafe water. The form is printed under the title WATER QUALITY EMERGENCY NOTIFICATION PLAN. It belongs to the county's water program forms and is not a business license. On FillingPDF you can fill out the form online and download or print the completed PDF; the original is published by EMD at the official URL.
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What is Emergency Notification Plan Form for Small Water Systems – Sacramento County, CA?
The Emergency Notification Plan Form for Small Water Systems is a Sacramento County Environmental Management Department form, printed as the WATER QUALITY EMERGENCY NOTIFICATION PLAN, in which a small water system names its emergency contacts and the ways it will warn its users of unsafe water.
The form is issued by the Environmental Compliance Division of the Sacramento County Environmental Management Department, part of the Countywide Services Agency. It has three working parts:
- The water system's identification: the name of the system, its system number (the line is printed beginning with 3400) and its physical location or address.
- The persons designated to implement the plan "upon notification that an imminent danger to the health of the water users exists", each with name and title, email address and day, evening and cell telephone numbers, followed by the Sacramento County contacts to be notified.
- The methods the system proposes to use to notify its consumers, with a space for an alternative method, and a "Report prepared by" signature and date.
The form states that users must be told that water must not be consumed until it is safe to do so. It also asks the operator to consider special organizations such as schools, non-English speaking groups and outlying water users, and to describe procedures that can actually be carried out in an emergency.
EMD lists the form under Small Public Water Systems on its Water Program and Well Forms page, alongside separate documents such as the Domestic Water Supply Permit Application and the Complete SSP (Sample Siting Plan). This form is the notification plan only; it does not apply for a permit.
Who needs to file Emergency Notification Plan Form for Small Water Systems – Sacramento County, CA?
The main group is the operator of a small water system in Sacramento County that must set out how it will notify its users of unsafe water. The form is published for small public water systems, and its text speaks of "small water system users" and of a water company with designated contacts.
Who completes which part:
- The water company names the persons designated to put the plan into action, with their email address and day, evening and cell telephone numbers.
- The person who prepares the report signs and dates the form under "Report prepared by".
- The system chooses its own notification methods and describes any alternative method.
Operators should also account for the groups the form lists: special organizations such as schools, non-English speaking groups and outlying water users.
The form is not a permit application or a sampling plan. EMD lists the Domestic Water Supply Permit Application and the Complete SSP (Sample Siting Plan) as separate documents on its water forms page. The form does not say who may sign on behalf of someone else, so ask EMD if the signer is not the person preparing the plan.
When to file Emergency Notification Plan Form for Small Water Systems – Sacramento County, CA
The plan is written before an emergency, because it names who will act "upon notification that an imminent danger to the health of the water users exists" and asks how you will notify users "in the event you must initiate your Emergency Notification Plan." The form prints no due date, renewal cycle or filing window of its own.
The notification the plan describes is immediate: users must be informed that water must not be consumed until it is safe to do so. If your system uses a telephone auto-dialer, the form requires that the calls include the Sacramento County Environmental Management Department contact. For any deadline that applies to your system, ask the department using the contact details under How to submit.
How to fill out Emergency Notification Plan Form for Small Water Systems – Sacramento County, CA
Identify the water system
Enter the name of the water system, the system number on the System No. line (printed beginning with 3400) and the physical location or address.
List the designated water company contacts
Under Water Company, enter each person's contact name and title, email address, and day, evening and cell telephone numbers. These are the people who will implement the plan when imminent danger to water users is reported.
Review the county contacts
The Sacramento County Departments table is pre-printed with Cheryl Hawkins, REHS, and the General Water Protection Phone. Line 3 is left open for an additional county contact if you have one.
Check your notification methods
Under I propose to notify my water consumers by the following method(s), mark each method you will use: post warnings in a conspicuous place, shutting off all water, door to door contact, written hand outs or telephone.
Describe any alternative method
In the line for the alternative method, write any other way you will notify consumers. Make sure it is practical and can be carried out in an emergency.
Account for special user groups
Check that your methods reach special organizations such as schools, non-English speaking groups and outlying water users, as the form directs.
Cover auto-dialer calls
If you notify by telephone auto-dialer, make sure the calls include the Sacramento County Environmental Management Department contact, as the form's note requires.
Sign, date and download the PDF
Enter the signature and date under Report prepared by, check every entry, then download or print the completed PDF from FillingPDF and contact EMD about delivery as described under How to submit.
How to submit Emergency Notification Plan Form for Small Water Systems – Sacramento County, CA
The form prints no submission channel, address or portal for the completed plan. It carries the department's contact details, so confirm the delivery route with the department before you send it.
- Department: Sacramento County Environmental Management Department, Environmental Compliance Division, 10590 Armstrong Avenue, Suite A, Mather, CA 95655.
- Phone and fax: phone (916) 875-8550; fax (916) 875-8513.
- County contacts listed on the form: Cheryl Hawkins, REHS, 916-875-8429 or 916-591-2638; General Water Protection Phone, 916-875-8400.
- Where the form is published: EMD Water Program and Well Forms, under Small Public Water Systems.
Sign and date the form before sending it. FillingPDF lets you fill out and download the PDF; submission follows the channels the agency confirms.
Common mistakes to avoid
- Leaving every notification method unchecked: the form asks you to acknowledge the methods you will use to notify water users.
- Describing a notification procedure you could not carry out in an emergency; the form says the procedures must be practical and actually implementable.
- Ignoring special organizations such as schools, non-English speaking groups and outlying water users, which the form says must be considered.
- Planning telephone auto-dialer notices without including calls to the Sacramento County Environmental Management Department contact, which the form requires.
- Listing designated persons without day, evening and cell telephone numbers or an email address, which the form asks for each contact.
- Sending the form without a signature and date under "Report prepared by".
- Treating the form as a permit application; the Domestic Water Supply Permit Application is a separate EMD document.
Frequently asked questions
What is the Emergency Notification Plan Form for Small Water Systems?
It is a Sacramento County Environmental Management Department form, printed as the Water Quality Emergency Notification Plan. A small water system uses it to name the people who will act and the methods it will use to warn users when unsafe water poses imminent danger.
Is this form a Sacramento County business license?
No. It is an emergency notification plan for small water systems, not a license. EMD lists it with other small public water system documents and keeps the Domestic Water Supply Permit Application as a separate form.
What notification methods does the form list?
The form lists five methods: post warnings in a conspicuous place, shutting off all water, door to door contact, written hand outs and telephone. It also has a line for an alternative method you propose.
What must I do if I use a telephone auto-dialer?
The form's note says emergency notifications issued by telephone auto-dialer must include calls to the Sacramento County Environmental Management Department contact. Build that contact into your call list when you describe the telephone method.
Who signs the Emergency Notification Plan Form?
The person who prepared the report signs and dates the form under "Report prepared by." The form does not describe any other signer, so ask EMD if someone else will sign for the water system.
Where do I send the completed form?
The form prints no delivery instructions. It lists the department at 10590 Armstrong Avenue, Suite A, Mather, CA 95655, phone (916) 875-8550 and fax (916) 875-8513, so confirm the delivery route with EMD before sending it.
Can I fill out this form online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent of the county and does not submit the plan to EMD; you deliver it through the channels EMD confirms.
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