Sd Eform-1371ld - Annual Consumer Confidence Report For Drinking Water Quality Certification Of Distribution

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SD EForm -
1371LD
V1
Annual Consumer Confidence Report for Drinking Water Quality
Certification of Distribution
I certify that the information contained in the consumer confidence report for the
EPA ID
is true and correct based upon my best information,
water system name
knowledge, or belief and that the report has been distributed as required and a good faith effort
has been made to reach all consumers. The
will make the consumer
water system name
confidence report available upon request and will keep it on file for five years.
Authorized Representative
Date
Save As
Clear Form
Print Form
NOTE: If the "Submit by Email" button does not automatically start a new email message with your completed form attached, then
use the "Save As" button and save the form to your PC. After that please go to your email program, start a new message addressed
to Mitch.Williams@state.sd.us, attach the form which you saved to your PC and then send the email message to Mitch.

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