Owner Statement of Responsibility Floatation System Facility Construction Permit Application I, , the undersigned owner, understand and accept the potential health risk and responsibilities associated with allowing bathers to bathe in float water that is treated by unproven float water treatment methods. I agree to close a floatation system to the public if the water quality does not meet the bacteriological standards specified below or if the Washington State Department of Health or the local health department determines that the floatation system is not safe for bathing. Bacteriological Standards: Heterotrophic plate counts may not exceed two hundred bacteria per milliliter. Total coliform may not exceed an average of one coliform per sample of one hundred milliliters when using the membrane filter test. Total coliform may not exceed 2.2 bacteria per sample of one hundred milliliters of water when using the most probable number (MPN) method. The owner shall close the floatation system to the public immediately after obtaining test results indicating a violation of the bacteriological standards specified above. The owner shall contact the local health department to discuss options for mitigation prior to re-opening. The Washington State Department of Health shall be notified of the mitigation for data tracking and analysis purposes. Owner Signature: Date:
Owner Statement of Responsibility Floatation System Facility Construction Permit Application I, , the undersigned owner, understand and accept the potential health risk and responsibilities associated with allowing bathers to bathe in float water that is treated by unproven float water treatment methods. I agree to close a floatation system to the public if the water quality does not meet the bacteriological standards specified below or if the Washington State Department of Health or the local health department determines that the floatation system is not safe for bathing. Bacteriological Standards: Heterotrophic plate counts may not exceed two hundred bacteria per milliliter. Total coliform may not exceed an average of one coliform per sample of one hundred milliliters when using the membrane filter test. Total coliform may not exceed 2.2 bacteria per sample of one hundred milliliters of water when using the most probable number (MPN) method. The owner shall close the floatation system to the public immediately after obtaining test results indicating a violation of the bacteriological standards specified above. The owner shall contact the local health department to discuss options for mitigation prior to re-opening. The Washington State Department of Health shall be notified of the mitigation for data tracking and analysis purposes. Owner Signature: Date:
333-223.docx