DDW-2024-008012

TIER 3 TEMPLATES

The following contain templates for Tier 3 violations and situations. Along with the templates are instructions, including the required method of delivery and instructions for completing
individual sections of the notices.

Mandatory language on unknown risk for monitoring violations, which must be included exactly as written, is presented in italics (R309-220-8(4)). All the language in the fluoride SMCL
template (except the language discussed below) is mandatory (R309-220-11).

You must also include the following italicized language in all notices, where applicable (R309-220-8(4)). Use of this language does not relieve you of your obligation to take steps reasonably
calculated to notify all persons served:

Please share this information with all the other people who drink this water, especially those who may not have received this notice directly (for example, people in apartments, nursing
homes, schools, and businesses). You can do this by posting this notice in a public place or distributing copies by hand or mail.

Templates

Monitoring Violations Annual NoticeB Coliform Monitoring (Tier 3)
Monitoring Violations Annual Notice – Chemical Monitoring (Tier 3)
Fluoride SMCL NoticeBTier 3