DDW-2025-007716

GCR Certification Form
CWS Name
PWSID No OqDOS
The community water system named above hereby confirms that its consumer confidence report has
been distributed to customers (and appropriate notices of availability have been given). Further, the
system certifies that the information contained in the report is correct and consistent with the compliance
monitoring data previously submitted to the state/primacy agency.
r
Title
Phone#: 3D/- lrSS - ?S DL Date:5-af- ar-
Please check all items that apply.
tr CCR was distributed by mail.
Date completed:
n CCR was distributed by other direct delivery method. Specifu direct delivery methods:
Date completed:
tr Mail - notification that CCR is available on Web site via a direct uniform resource
locator (URL)
E E-mail - direct URL to CCR
E E-mail - CCR sent as an attachment to the e-mail
E E-mail - CCR sent embedded in the e-mail
I Other:
If the CCR was provided by a direct URL, please provide the direct URL Internet address:
www
If the CCR was provided electronically, please describe how a customer requests paper CCR
delivery:
Revised April2013
April2010
CCR Rule Implementation Guidance 38
t