Cross Connection Report 
Community water supplies must report annually on the status of their cross connection program to the DEQ district office by March 31 of each year.  Download the appropriate version of the form:

• Cross Connection Report in Word or PDF 
• Cross Connection Report for Systems Serving Only Residential Accounts in Word or PDF 

Bacteriological Sample Siting Plan in Word or PDF 
Water supplies must have a current sample siting plan detailing sampling locations for routine and follow-up bacteriological monitoring.

Disinfectants and Disinfection Byproducts Monitoring Plan
Community water supplies that serve disinfected water must have a monitoring plan detailing sampling locations, sampling dates, and compliance calculation procedures for disinfectants and disinfection byproducts monitoring.

• DDBP Monitoring Plan in Word or PDF 
• DDBP Monitoring Plan in Word or PDF for water plants treating surface water using conventional filtration
• Instructions for nonconsecutive supplies (not connected to another public water supply)
• Instructions for consecutive supplies (purchase water from or sell water to another public water supply)

Lead and Copper Report and Consumer Notice of Lead Result Certificate in Word or PDF 
This form supersedes two older forms, the Lead and Copper Reporting Form and the Consumer Notice of Lead Results Certificate.  Water supplies must report lead and copper monitoring information to the DEQ district office within 10 days after the end of the lead and copper monitoring period.  Additionally, water supplies must provide a notice of the individual tap result from lead tap water monitoring to occupants of the home or building tested within 30 days of knowing the result.  A water supply may use the suggested format provided in this form.  The water supply must certify that the requirement was met and send the certification along with a sample of the notice to the DEQ district office.  Water supplies may use the certificate provided in this form.

Water Quality Parameters:  Water supplies may report water quality parameter monitoring on the Monthly Operation Report or on this addendum to the Lead & Copper Report for Water Quality Parameters in Word or PDF.

CCR Certificate of Distribution in Word or PDF 
Community water supplies must submit a certificate to the DEQ district office immediately following delivery of the annual Consumer Confidence Report confirming that the CCR is correct and has been distributed as required.

Emergency Response Plan in Word or PDF 
This form replaces the Contingency Plan.  Community water supplies must prepare plans and procedures and identify personnel and equipment that can be used in the event of an emergency.  The Emergency Response Plan outlines a program for rapid correction or mitigation of emergencies to significantly lessen the impact of the emergency on the public health and the safety and supply of drinking water provided to the public.  Water supplies with a Contingency Plan will transition to the Emergency Response Plan according to the update schedule contained in the Contingency Plan.

Stipulate to Conditions for Private Ownership of Public Water Supply
The owner of a privately owned Community Water Supply (CWS) must stipulate to conditions required by the department to ensure the CWS will meet the requirements of the act and rules.  The stipulation is required of owners of proposed water supplies, new owners of existing water supplies, and owners of water supplies whose classification is changed to CWS.  This stipulation is only one of many requirements on privately owned CWS.  Contact the appropriate Department of Environmental Quality (DEQ) district office to discuss requirements.

DEQ districts serving Community Water Supplies 
Addresses of the 8 DEQ district offices overseeing community water supplies and the counties they serve.
DEQ district map with telephone numbers of DEQ staff that oversee the community water supply program and the counties they serve.