Form CEHS-5 (E) "Child Care Center - Indoor Environmental Health Assessment - Water and Sewer Information" - New Jersey

What Is Form CEHS-5 (E)?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2012;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CEHS-5 (E) by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form CEHS-5 (E) "Child Care Center - Indoor Environmental Health Assessment - Water and Sewer Information" - New Jersey

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New Jersey Department of Health
Consumer, Environmental and Occupational Health Service
Environmental and Occupational Health Assessment Program
PO Box 369, Trenton, NJ 08625-0369
Child Care Center - Indoor Environmental Health Assessment
FORM E: WATER AND SEWER INFORMATION
Facility Name
Street Address
City
County
Directions: Provide the following information. Use an additional sheet if necessary.
I. Potable Water Supply
Is the potable water certified to meet NJ DEP safe drinking water standards?
Yes
No
Check type of water supply:
On-site Well - Depth of well: _________________________
Depth of pump set at: ____________________
Public Community Water System
II. Waste System (Check one)
Septic System:
Size:
Location:
Describe Condition:
Cesspool:
Size:
Location:
Describe Condition:
Public Community Sewer System
III. Comments or Concerns
Indicate any comments or concerns regarding any of the above:
CEHS-5
AUG 12
New Jersey Department of Health
Consumer, Environmental and Occupational Health Service
Environmental and Occupational Health Assessment Program
PO Box 369, Trenton, NJ 08625-0369
Child Care Center - Indoor Environmental Health Assessment
FORM E: WATER AND SEWER INFORMATION
Facility Name
Street Address
City
County
Directions: Provide the following information. Use an additional sheet if necessary.
I. Potable Water Supply
Is the potable water certified to meet NJ DEP safe drinking water standards?
Yes
No
Check type of water supply:
On-site Well - Depth of well: _________________________
Depth of pump set at: ____________________
Public Community Water System
II. Waste System (Check one)
Septic System:
Size:
Location:
Describe Condition:
Cesspool:
Size:
Location:
Describe Condition:
Public Community Sewer System
III. Comments or Concerns
Indicate any comments or concerns regarding any of the above:
CEHS-5
AUG 12