CONTACT/OPERATOR INFORMATION UPDATE Please Return Completed Form to: MT DEQ - WWOC P.O. Box 200901 Helena, MT 59620-0901 This form constitutes a notice of intent from the water or wastewater system listed below to the State of Montana, Department of Environmental Quality (department) for the purpose of providing a means to fulfill the statutory obligation under Section 37-42-302, Montana Codes Annotated (MCA). This MCA requires that all wastewater treatment plants, water treatment plants, or water distribution systems be operated under the supervision of a fully certified operator in responsible charge to ensure the proper management, operation, and maintenance of the system. SYSTEM NAME: Date: PWSID#: or MPDES#: System Type: Community Water System Non-transient Non-community Water System Public Sewage System Permitted Wastewater System System Information # of Active Service Connections: # of Total Service Connections: Non-Resident Population: Resident Population: Seasonal End Date: Seasonal System: Y or N If Yes, Seasonal Start Date: Type of Treatment: (give a brief description of the type of treatment used for water and/or wastewater system): Owner Information (Use mayor if incorporated; use president, if incorporated district, HOA, or WUA): Name: Phone #: Mailing Address: Business Email: City, State & Zip Code: Administrative Contact (Person that all system correspondence should be sent to): Name: Phone #: Mailing Address: Business Email: City, State & Zip Code: Financial Contact Name: Phone #: Mailing Address: Business Email: City, State & Zip Code:
CONTACT/OPERATOR INFORMATION UPDATE Please Return Completed Form to: MT DEQ - WWOC P.O. Box 200901 Helena, MT 59620-0901 This form constitutes a notice of intent from the water or wastewater system listed below to the State of Montana, Department of Environmental Quality (department) for the purpose of providing a means to fulfill the statutory obligation under Section 37-42-302, Montana Codes Annotated (MCA). This MCA requires that all wastewater treatment plants, water treatment plants, or water distribution systems be operated under the supervision of a fully certified operator in responsible charge to ensure the proper management, operation, and maintenance of the system. SYSTEM NAME: Date: PWSID#: or MPDES#: System Type: Community Water System Non-transient Non-community Water System Public Sewage System Permitted Wastewater System System Information # of Total Service Connections: Resident Population: # of Active Service Connections: Non-Resident Population: Seasonal System: Y or N If Yes, Seasonal Start Date: Seasonal End Date: Type of Treatment: (give a brief description of the type of treatment used for water and/or wastewater system): Owner Information (Use mayor if incorporated; use president, if incorporated district, HOA, or WUA): Name: Phone #: Mailing Address: Business Email: City, State & Zip Code: Administrative Contact (Person that all system correspondence should be sent to): Name: Phone #: Mailing Address: Business Email: City, State & Zip Code: Financial Contact Name: Phone #: Mailing Address: Business Email: City, State & Zip Code:
SystemOpUpdate_new.docx