TX Name of Entity: PWS ID No.: If this project HAS NOT received a funding commitment, provide the associated Project Information Form number(s) (PIF #) for this update. If the project HAS received a funding commitment, provide the associated five-digit Project number for this update. Section 1. GENERAL INFORMATION Name of Entity County (City, Town, County, District, PWS, WSC, etc.) PWS ID No. CCN No. TX Name of Project Proposed Total Project Costs (Provide a brief name for this project.) (Section 10, Line P.) Engineering Firm Contact Information Entity Contact Information Name of Firm Contact Person Contact Person Title & Department & Department Mailing Address Mailing Address Phone Number Phone Number Email Address Email Address Section 2. SERVICE AREA INFORMATION Attach and submit a map of the entity’s current and, if applicable, proposed service area. The map of the service area must be overlaid by a map of the census boundaries in the service area. To determine population served indicate the number of people who reside within the service area of, or receive wholesale or retail water service from, the entity based on the most recent . For an unincorporated entity (i.e., a county, district, river authority, system, or corporation) provide a table that 1) identifies the number of household connections within each block group that covers the entity’s service area and 2) prorates the population accordingly. See example table in . Population Served Total Household Connections Section 3. PROJECT CATEGORY Check the ONE category that best describes the project. Projects that involve multiple categories must be submitted separately. Source Water Protection Public Water System (PWS) Must also submit Form DW-010.
Name of Entity: PWS ID No.: TX If this project HAS NOT received a funding commitment, provide the associated Project Information Form number(s) (PIF #) for this update. If the project HAS received a funding commitment, provide the associated five-digit Project number for this update. Section 1. GENERAL INFORMATION Name of Entity (City, Town, County, District, PWS, WSC, etc.) County PWS ID No. CCN No. TX Name of Project (Provide a brief name for this project.) Proposed Total Project Costs (Section 10, Line P.) Entity Contact Information Engineering Firm Contact Information Name of Firm Contact Person Contact Person Title & Department & Department Mailing Address Mailing Address Phone Number Phone Number Email Address Email Address Section 2. SERVICE AREA INFORMATION Attach and submit a map of the entity’s current and, if applicable, proposed service area. The map of the service area must be overlaid by a map of the census boundaries in the service area. To determine population served indicate the number of people who reside within the service area of, or receive wholesale or retail water service from, the entity based on the most recent . For an unincorporated entity (i.e., a county, district, river authority, system, or corporation) provide a table that 1) identifies the number of household connections within each block group that covers the entity’s service area and 2) prorates the population accordingly. See example table in . Population Served Total Household Connections Section 3. PROJECT CATEGORY Check the ONE category that best describes the project. Projects that involve multiple categories must be submitted separately. Public Water System (PWS) Source Water Protection Must also submit Form DW-010.
DW_Sections_1-3_update_worksheet.docx