Notice to Affected Household and Confirmation Notice– Sample Template B Template for public water system to send notice to households of their lead results and provide confirmation to EPA and MassDEP: TEMPLATE B - For households where the public water system’s 90th percentile level in their most recent sampling round and the household’s drinking water lead sample result are greater than 15 ppb. Instructions: Fill in the correct case-specific information in sections marked with brackets. Please remove the brackets before distributing the letter. Sections in italics are required and include: A clear explanation of the potential adverse effects on human health of drinking water that contains a concentration of lead that exceeds the lead action level; The steps that the owner or operator of the public water system is taking to mitigate the concentration of lead; and The necessity of seeking alternative water supplies until the date on which the concentration of lead is mitigated. Translations for English Instructions – Brief translations in 27 languages for non-English speakers conveying the importance of this report. [INSERT PWS NAME] Important Information about Your Drinking Water Lead Sample Results for Your Home Dear [Consumer's Name], EPA has provided us with information regarding a lead sample of drinking water taken at your home. This sample was collected by [sampler information] on [sample date]. The sample shows lead levels that are greater than the lead action level of 15 ppb. The 90th percentile value of all the samples collected throughout our entire water system for compliance with the Lead and Copper Rule is also greater than the lead action level. [Insert PWS name ] strongly urges you to take the steps listed on the next page to reduce your exposure to lead in drinking water. The following table shows the results of the water sample: Sample Lab Results Lead Test Action Level at 90th MCLG Collected Received by Homeowner(s) Results Percentile Level
Notice to Affected Household and Confirmation Notice– Sample Template B Template for public water system to send notice to households of their lead results and provide confirmation to EPA and MassDEP: TEMPLATE B - For households where the public water system’s 90th percentile level in their most recent sampling round and the household’s drinking water lead sample result are greater than 15 ppb. Instructions: Fill in the correct case-specific information in sections marked with brackets. Please remove the brackets before distributing the letter. Sections in italics are required and include: A clear explanation of the potential adverse effects on human health of drinking water that contains a concentration of lead that exceeds the lead action level; The steps that the owner or operator of the public water system is taking to mitigate the concentration of lead; and The necessity of seeking alternative water supplies until the date on which the concentration of lead is mitigated. Translations for English Instructions – Brief translations in 27 languages for non-English speakers conveying the importance of this report. [INSERT PWS NAME] Important Information about Your Drinking Water Lead Sample Results for Your Home Dear [Consumer's Name], EPA has provided us with information regarding a lead sample of drinking water taken at your home. This sample was collected by [sampler information] on [sample date]. The sample shows lead levels that are greater than the lead action level of 15 ppb. The 90th percentile value of all the samples collected throughout our entire water system for compliance with the Lead and Copper Rule is also greater than the lead action level. [Insert PWS name ] strongly urges you to take the steps listed on the next page to reduce your exposure to lead in drinking water. The following table shows the results of the water sample: Sample Collected Lab Results Received by Homeowner(s) Lead Test Results Action Level at 90th Percentile Level MCLG
wiin-template-b.docx