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Home My WebLink AboutDDW-2024-010947Utah Division of Drinking Water IPS Deficiency Correction Notice Water System Name_________________________________________________ Water System ID #UTAH________ Instructions Please use this form to report the correction of sanitary survey deficiencies identified on your IPS report. List the individual Facility ID (where applicable), deficiency code, how deficiency was corrected and the date of the correction below. You may attach a copy of your IPS report with the date of the correction noted on the report. Pictures of corrections or a brief description of the corrections are encouraged. Include the name of the facility and the correction date on any documentation you provide. Facility ID Deficiency Code How deficiency was corrected Date Corrected I certify that the information submitted with this report is true and accurate. You may electronically sign this form by typing your name in the Signature block. Print Name Signature Date Corrections listed on attached IPS report Supportive documentation attached DDW Approval______________________________________ Date_____/_____/_____ Print Form 02060 ST003 ST002 Replaced gaskets Replaced gaskets 09/09/2024 09/09/2024 Jason L Harrison 09/10/2024Jason L Harrison Utah Test and Training Range Submit by Email V009 V009 UT02060 ST002 Replaced Hatch Gasket 09 September 2024 UT02060 ST003 Replaced Hatch Gasket 09 September 2024 Contacts Type: Administrative Contact Name: COLBY KAY GOODLIFFE Office: 801-695-9785 Emergency: Email: colby.goodliffe@amwater.com colby.goodliffe@gmail.com Site Information Legal Contact: GOODLIFFE, COLBY KAY Address: 7834 NORTH DRIVE BUILDING 1909, HILL AFB, UT 84056 Phone: 801-695-9785 County: BOX ELDER COUNTY System Type: Non-Transient Certification Required: SS T1 Total Population: 63 Local Health District: Bear River Health Department Site Updates Last Inventory Update: 08/23/2024 Last Surveyor Update: 07/19/2024 Surveyor: HUNTER PAYNE Operating Period: 1/1 - 12/31 Last IPS Update: 08/30/2024 07:10:00 Political Districts Legislative District Map Water Usage Information per ERC Total Ips Points: 0 Public Water System IPS ReportDEQ | Drinking Water Utah Test And Training Range PWS ID: UTAH02060 Rating: Approved 09/11/2014 Status: Active IPS SUMMARY Total IPS Points: 0 Admin & Physical Facilities Quality & Monitoring Significant Deficiency Violations 0 0 0 PHYSICAL FACILITY POINTS Total Pts: 0 Facility Facility Name Status Points Effective Details ST003 STORAGE TANK #3 BLDG 40052 A 0 Hide Details ( 1 ) Code Description Severity Comments DeterminedDate Pending Assessed V009 STORAGE TANK LID LACKS A FUNCTIONING GASKET BETWEEN THE LID AND FRAME SIG Gaps between strips of rubber gasket prevent the gasketfrom providing a complete seal.07/19/2024 25 0 SIGNIFICANT DEFICIENCY VIOLATIONS Total Pts: 0 ID Violation Code Deficiency Determined Points Effective LEAD COPPER MONITORING AND QUALITY VIOLATIONS Total Pts: 0 Violation No.Period Code Description/Name Points Effective https://waterlink.utah.gov/reports.html?systemId=392 1/3 CHEMICAL MONITORING RULE VIOLATIONS Total Pts: 0 Facility Violation No Period Code Violation Type Analyte Group Determined Seasonality Points Effective TREATMENT VIOLATIONS Total Pts: 0 Facility Violation No Period Code Violation Type Analyte Group Determined Points Effective MICROBIAL RULE VIOLATIONS Date Range Start: 07/01/2023 Total Pts: 0 Determine Date Compliance Period Code Violation Type Return To Compliance Points Effective OPERATOR CERTIFICATION Type Level Required Highest Certificate Distribution Small System Dist 4 Treatment Treat 1 Treat 4 CONSUMER CONFIDENCE REPORT Total Effective Points: 0 Violation No.Period Code Description/Name Points Effective PUBLIC NOTIFICATION VIOLATIONS Total Pts: 0 Violation No.Date Code Description/Name Points Effective https://waterlink.utah.gov/reports.html?systemId=392 2/3 IPS COMPLIANCE SCHEDULES Type Required Activities Severity Created Due Physical deficiency schedule STORAGE TANK LID LACKS A FUNCTIONING GASKET BETWEEN THE LID AND FRAME SIG 08/15/2024 12/13/2024 Lead Copper Rule Revisions COMPLETE INITIAL LSL INVENTORY 12/16/2021 10/16/2024 Lead Copper Rule Revisions SUBMIT LEAD SERVICE LINE INVENTORY 12/16/2021 10/16/2024 https://waterlink.utah.gov/reports.html?systemId=392 3/3