"Certification of Public Water System Emergency Response Plan - Transient Non-community Public Water Systems" - Rhode Island

Certification of Public Water System Emergency Response Plan - Transient Non-community Public Water Systems is a legal document that was released by the Rhode Island Department of Health - a government authority operating within Rhode Island.

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Certification of Public Water System Emergency Response Plan
Transient Non-Community Public Water Systems
Part (A): Public Water System Identification
Public water system name:
Public water system complete mailing address:
Public water system identification number:
Population served:
Part (B): Certification Date
Date of the certification: ____________________
Part (C): Certification Statement
I, [Name of certifying official]
hereby certify that
an emergency response plan (hereafter, Plan) has been developed for the public water system
named under Part A and is in compliance with the requirements of § 1.9.9 of the Rhode Island
Department of Health Drinking Water Regulations (216-RICR-50-05-1). This Plan will be
maintained, will be updated as is necessary to incorporate changes and at a minimum interval
of every five years, and will be implemented to mitigate the effects of applicable hazards. By
checking off and signing below, I attest that the Plan includes:
Names, telephone numbers, and email addresses for the PWS owner and all other
emergency contacts that will be responded to twenty-four (24) hours a day, seven (7)
days a week;
Names and telephone numbers for external emergency contacts including the
Department of Health, Department of Environmental Management, police, and fire;
Procedures for notification of emergency contacts;
Emergency public notification procedures and templates;
A list of immediate actions to be taken during emergency situations;
Written plans for ensuring all personnel have knowledge of the Plan, its location,
and the emergency procedures outlined in the Plan;
Updates from recent, significant changes to the systems and operations and maintenance
procedures;
Certification of Public Water System Emergency Response Plan
Transient Non-Community Public Water Systems
Part (A): Public Water System Identification
Public water system name:
Public water system complete mailing address:
Public water system identification number:
Population served:
Part (B): Certification Date
Date of the certification: ____________________
Part (C): Certification Statement
I, [Name of certifying official]
hereby certify that
an emergency response plan (hereafter, Plan) has been developed for the public water system
named under Part A and is in compliance with the requirements of § 1.9.9 of the Rhode Island
Department of Health Drinking Water Regulations (216-RICR-50-05-1). This Plan will be
maintained, will be updated as is necessary to incorporate changes and at a minimum interval
of every five years, and will be implemented to mitigate the effects of applicable hazards. By
checking off and signing below, I attest that the Plan includes:
Names, telephone numbers, and email addresses for the PWS owner and all other
emergency contacts that will be responded to twenty-four (24) hours a day, seven (7)
days a week;
Names and telephone numbers for external emergency contacts including the
Department of Health, Department of Environmental Management, police, and fire;
Procedures for notification of emergency contacts;
Emergency public notification procedures and templates;
A list of immediate actions to be taken during emergency situations;
Written plans for ensuring all personnel have knowledge of the Plan, its location,
and the emergency procedures outlined in the Plan;
Updates from recent, significant changes to the systems and operations and maintenance
procedures;
Acknowledgement that the PWS will report to RIDOH within seventy-two (72) hours of
contact info change; and
Designation of Plan storage location that will remain readily accessible in the
event of an extended emergency.
I attest to the accuracy of the above and certify that it is in compliance with 216-RICR-50-05-
1.9.9,
[Certifying official – Signature and DATE]
[Certifying official – Printed name]
[Certifying official - Phone]
[Certifying official - Email]
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