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Home My WebLink AboutDDW-2024-006741Utah Division of Drinking Water IPS Deficiency Correction Notice Water System Name_________________________________________________ Water System ID #UTAH________ 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_____/_____/_____ 16003 TP001 DS001 DS001 DS001 DS001 Ammonia Hydroxide solution acquired Local Authority Statement Provided Public Education Material mailed out CCC Written Records Updated CCC Enforcement Implementation 03/05/2024 03/05/2024 03/05/2024 03/05/2024 03/05/2024 John Chartier 03/05/2024John Chartier Marysvale Town TD14 M004 M006 M007 M003