DDW-2025-002112

Print Form Submit by Email
Utah Division of Drinking Water
IPS Deficiency Correction Notice
Water System Name Syracuse City Water System
Water System ID #UTAH 06012
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
ST002 V008 Added new tank access lid w/18" height Feb 12. 2025
ST002 V012 Added screen to correct drain pipe Feb 13. 2025
I certify that-the-information-submitted-with this-report is true and aceurate. You may-
electronically sign this form by typing your name in the Signature block.
Angela Jones
Print Name
ayours
Signature
Corrections listed on attached IPS report☑
DDW Approval
Mar 3. 2025
Date
Supportive documentation attached ☑
Date / /