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Home My WebLink AboutDDW-2024-012272Utah 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 23023 23023 23023 TP002/Well 2 Distributed CCC Flyer to TEAD-S mail list Emailed annual BFV inspection forms to Gary Rager Provided ANSI/NSF 60 documentation for chlorine gas Oct 15, 2024 Oct 15, 2024 Oct 15, 2024 Jason Rawls Oct 15, 2024Jason Rawls TOOELE ARMY DEPOT SOUTH AREA (TEAD-S) Submit by Email M004 TD90 M007