The Request for Reclassification & Certification Form is the Sacramento County Environmental Management Department (EMD) form on which a small water system asks EMD to reclassify it under Section 116275 of the California Health and Safety Code (CHSC). The water system's representative reports connection and population counts and certifies that the information is true. You can fill out the form online on FillingPDF and download or print the completed PDF; the PDF itself is published by EMD, which also decides the request.
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What is Request for Reclassification & Certification Form – Sacramento County, CA?
The Request for Reclassification & Certification Form is the Sacramento County Environmental Management Department (EMD) form that a small water system uses to ask EMD to reclassify the system under Section 116275 of the California Health and Safety Code (CHSC).
The PDF is headed Small Water System Request for Reclassification and Certification. It opens with the water system's name and its LPA Number (printed as 3400 followed by blanks). The requester then checks the box for the system's current classification:
- Community Water System
- Non-Transient noncommunity Water System
- Transient-noncommunity Water System
- State Small Water System, described on the form as a system serving 5 to 14 service connections that does not serve drinking water to an average of 25 individuals daily for more than 60 days a year.
Items 1 to 5 collect the facts EMD uses to consider the change: service connections, yearlong residences, people served for six months of the year, and other people served daily, with average and peak figures in items 5.a to 5.d. A final statement lets the system say it does not provide water to more than 25 people 60 days a year and is therefore not a public water system.
Page 2 is a certification. The signer confirms the information is true and correct and that they are authorized by the water system to submit the request. EMD evaluates the information and notifies the water system of its decision; the form says an inspection may be needed. EMD lists the form on its Water Program and Well Forms page under Small Public Water Systems.
Who needs to file Request for Reclassification & Certification Form – Sacramento County, CA?
The form is for a representative of a small water system who wants Sacramento County EMD to change the system's classification. The form asks which classification applies now: Community Water System, Non-Transient noncommunity Water System, Transient-noncommunity Water System or State Small Water System.
The person who signs must be a water system representative. By signing, they certify that the information is true and correct to the best of their knowledge and that the water system has authorized them to submit the request. The form gives no other rule on who may sign for the system.
A system that does not provide water to more than 25 people 60 days a year can check Yes on the statement that it is not a public water system; the form pairs that statement with the request, so use it only if it is accurate for your system.
The form is specific to water system classification. It does not ask for a permit, and EMD's water forms page lists the Domestic Water Supply Permit Application, the Complete SSP (Sample Siting Plan) and the Emergency Notification Plan Form for Small Water Systems as separate documents.
When to file Request for Reclassification & Certification Form – Sacramento County, CA
File the form when your small water system wants EMD to reclassify it from the classification it holds now. The form prints no due date and no renewal cycle, so timing depends on when the water system's circumstances, such as its connections or the number of people it serves, support a different classification.
Have your counts ready before you start: service connections, connections serving yearlong residents, yearlong residences, the same people served 6 months of the year (including all employees and students), and the daily and monthly averages and peaks asked in items 5.a to 5.d.
After you submit, EMD evaluates the information and notifies the water system of its decision. The form states that an inspection may be needed to complete the evaluation, and it gives no processing time. EMD's water forms page shows this form as updated 07/05/2022.
How to fill out Request for Reclassification & Certification Form – Sacramento County, CA
Enter water system name and LPA number
At the top of page 1, write the water system name and complete the LPA Number, which is printed as 3400 followed by blanks.
Check the current classification
Check the box that matches how your system is classified now: Community Water System, Non-Transient noncommunity Water System, Transient-noncommunity Water System or State Small Water System. Compare your system with the description printed beside each box.
Count service connections
Item 1: the number of service connections. Item 2: the number of service connections that serve yearlong residents.
Count residences and regular users
Item 3: the number of yearlong residences. Item 4: the number of same people served 6 months of the year, including all employees and students.
Report other people served daily
Item 5: the number of other people served daily who are not already counted in items 3 and 4.
Enter averages and peaks
Item 5.a: average people served daily. Item 5.b: peak number served on any day. Item 5.c: average served in a month. Item 5.d: peak served in a month.
Answer the public water system statement
Check Yes only if the water system does not provide water to more than 25 people 60 days a year and is therefore not a public water system. Leave it unchecked if that is not true for your system.
Read the page 2 certification
The certification quotes CHSC Section 116725 on civil penalties for knowingly false statements and Section 116730 on criminal prosecution. By signing, you certify the information is true and that you are authorized by the water system to submit the request.
Sign and add contact details
Sign as the Water System Representative and enter the date. Then print your name, your title and a contact phone number.
Review and download the completed PDF
Check that every blank on page 1 is filled and that page 2 is signed and dated. Download or print the completed PDF from FillingPDF, then send it to EMD as described under How to submit.
How to submit Request for Reclassification & Certification Form – Sacramento County, CA
The form does not print a filing channel, so confirm with EMD how it takes the request before you send it. The EMD letterhead on the form lists these contact details:
- Address: Environmental Management Department, 11080 White Rock Road, Suite 200, Rancho Cordova, CA 95670
- Fax: (916) 875-8513
- Environmental Compliance: (916) 875-8550
- Environmental Health: (916) 875-8440
- Website: emd.saccounty.gov
EMD publishes the form on its Water Program and Well Forms page, under Small Public Water Systems.
Sign and date page 2 before sending it, with the printed name, title and contact phone number of the water system representative. EMD then evaluates the request and notifies the water system of its decision; an inspection may be needed. FillingPDF lets you fill out and download the PDF; submission follows EMD's channels.
Common mistakes to avoid
- Leaving blanks in items 1 to 5, when the form asks you to fill in each blank so EMD has enough information to consider the reclassification.
- Checking no box, or the wrong box, for the system's current classification: community, non-transient noncommunity, transient-noncommunity or state small.
- Leaving out the water system name or the LPA Number at the top of page 1.
- Checking Yes on the "not a public water system" statement when the system does provide water to more than 25 people 60 days a year.
- Omitting the average and peak figures in items 5.a to 5.d when other people are served daily beyond those counted in items 3 and 4.
- Sending page 1 without the page 2 certification, or leaving the signature, date, printed name, title or contact phone number blank.
- Having someone sign who is not authorized by the water system to submit the request.
- Treating the request as approved on submission; EMD evaluates it, may inspect and notifies the water system of its decision.
Frequently asked questions
What is the Request for Reclassification & Certification Form?
It is a Sacramento County Environmental Management Department (EMD) form on which a small water system asks EMD to reclassify it under CHSC Section 116275, based on its service connections and the people it serves. EMD evaluates the information and notifies the water system of its decision.
Is this the form for a Sacramento County business license?
No. This form asks EMD to reclassify a small water system and has the water system's representative certify the information; it is not a license application. EMD's water forms page lists a separate Domestic Water Supply Permit Application under Small Public Water Systems.
Who can sign the reclassification request?
A water system representative who certifies being authorized by the water system to submit the request. The signer also prints their name, title and contact phone number and dates the signature. The form sets no other signature rules.
Is there a deadline to file the reclassification request?
The form prints no deadline. You file it when your water system wants EMD to reclassify it. EMD then evaluates the information, notifies the system of its decision, and may inspect before deciding. Call EMD if you need timing for your case.
What do items 5.a to 5.d ask for?
They apply to other people served daily who are not counted in items 3 and 4: the average number served daily (5.a), the peak on any day (5.b), the average in a month (5.c) and the peak in a month (5.d).
What happens if I put false information on the form?
The certification quotes CHSC Section 116725, which allows a civil penalty for each separate violation, or each day of a continuing violation, for knowingly false statements. Section 116730 says violators may be prosecuted in criminal court and punished by a fine, up to one year in county jail, or both.
What happens after I submit the request?
EMD evaluates the information you provided and notifies the water system of its decision. The form says an inspection may be needed to complete the evaluation. For questions, EMD lists Environmental Compliance at (916) 875-8550 and Environmental Health at (916) 875-8440.
Can I fill out the reclassification form online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not submit the form to EMD; you send it through EMD's channels.
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