ensure proper (Cross The Leaking Unprotected, Unprotected, treatment system No emergency function. high high components hazard hazard plant response is not plan were being (ERP). identified operated Is the [describe type Does to prevent and present. location]. (See the present. inadequately (See The Emergency Does Were photo photo treated #) #)(see water (see Response Plan each there examples listed plant [Describe from examples being listed (ERP) must high below) any being have sent below) to the potential detail an concern distribution and emergency system. For remedy] operations only) Noncommunity procedures for Stock to provide a During possible Systems the Only: in the tanks pathway sanitary tanks survey for are foreseeable plan contamination high hazard the emergencies operator – (ERP) to enter the cross demonstrated such as power drinking connections water lack outage, of loss of – or by the air system during water, because operational of the gap or potential backflow understanding for events equipment does and therefore or failure, protozoan, other limiting that water not present bacterial conditions a and development of are need from potential viral public unsafe existed have to not being health threat. [describe]. contamination. conditions, and the sent to show An The approved survey air other [Describe the the at identified gap potential emergency or the [specify atmospheric concern and the conditions. air tank? cross remedy] Templates, breaker gap or the connection or including greater ERP found backflow during instructions, for the survey] as a prevention developing high device hazard must be ERPs may be cross found installed on at the the tank(s). A USEPA Region reduced 8 Drinking pressure Water Online backflow website: . Select assembly (RPZ) the “Emergency or air gap must Response Plan be installed at Templates” link the service on the main connection to page. this facility. An RPZ must be inspected and tested at least annually to ensure proper function.
ensure proper function. Does each high in the or have the air gap or Unprotected, high hazard present. (See photo #) (see examples listed below) provide a pathway for contamination to enter the drinking water system during backflow events and therefore present a potential public health threat. The survey identified [specify the cross connection found during the survey] as a high hazard cross A reduced pressure backflow assembly (RPZ) or air gap must be installed at the service connection to this facility. An RPZ must be inspected and tested at least annually to ensure proper function. (Cross Were there any by the that are not Leaking system components were identified [describe type and location]. [Describe potential concern and remedy] only) Stock tanks – air gap or at the tank? Unprotected, high hazard present. (See photo #)(see examples listed below) For Noncommunity Systems Only: tanks are high hazard cross connections because of the potential for protozoan, bacterial and viral contamination. An approved air gap or atmospheric breaker or greater backflow prevention device must be installed at the tank(s). Is the plant being to water from being sent to the The treatment plant is not being operated to prevent inadequately treated water from being sent to the distribution system. During the sanitary survey the operator demonstrated lack of operational understanding or other limiting conditions existed [describe]. [Describe potential concern and remedy] Does the have an plan (ERP) – does not need to show the the ERP No emergency response plan (ERP). The Emergency Response Plan (ERP) must detail emergency operations procedures for possible foreseeable emergencies such as power outage, loss of water, equipment failure, development of unsafe conditions, and other emergency conditions. Templates, including instructions, for developing ERPs may be found on the USEPA Region 8 Drinking Water Online website: . Select the “Emergency Response Plan Templates” link on the main page.
ss_tribal_form.docx