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DEPARTMENT Environmental Health Division <br /> � HEALTH Drinking Water Protection Section <br /> P.O. Box 64975 <br /> St. Paul, Minnesota 55164-0975 <br /> Phone: 651-201-4700 <br /> Source Water Protection Plan Implementation Grant Application <br /> Applicant Information <br /> Public Water System Name: City of Centerville PWSID: 1020036 <br /> Street Address: 1880 Main Street Apartment/Unit#: <br /> city: Centerville County: Anoka zip: 55038 <br /> Name of the person who will serve as the Grant Contact: Mark StatZ <br /> Phone: 651-429-3232 Fax: 651-429-8629 Email: mstatz&centervillemn.com <br /> Federal Tax Id#: 41-1267014 <br /> Person Authorized To Sign Application and Grant Agreement on Behalf of the Public Water System <br /> Name: Mark Statz Title: Citv Administrator <br /> Amounts <br /> Total cost of the project: $ 9,972.00 <br /> Amount requested from MDH (minimum $1,000, maximum $10,000, or$30,000 if 3 or more PWS's apply <br /> jointly): $ 9,972.00 <br /> Check this box if you are currently under an APO (administrative penalty order) in <br /> regards to the Wellhead protection rule. <br /> Work Item 1 <br /> For each work item to be funded under the grant, provide the following information (use an additional page if <br /> necessary). <br /> Check this box if the work is a continuation from a previous MDH grant <br /> 1. Describe the work that will be performed: <br /> Update potential contamination sources within the DWSMA using state databases as a <br /> starting point, then updating with locally available information. Update the status of existing <br /> sites in the PCSI if that status has changed. <br /> If the work item is about managing one or more potential contaminant sources, are they located in the <br /> DWSMA? • Yes ONo <br /> 1a. Amount requested for performing this Work: $ 4,110 <br /> 1b. Anticipated outcomes (products) of performing this work: <br /> The PCSI and spills inventory in the Wellhead Protection Plan will be updated with the most current <br /> information. This will allow Centerville to prioritize the sites of greatest concern and concentrate future <br /> implementation efforts on those sites, in order to minimize the risks of contaminating the aquifer <br /> serving the community's drinking water supply wells. <br /> 1c. Management Strategy/Measure number:Action IIIA Reference the Strategy/Measure <br /> number in the MDH source water protection approved plan (NOT the Draft Copy) or intake protection plan <br /> that will be supported by this work item.Attach the page(s)that contain(s)the source water protection <br /> strategy/measure; <br /> 92 <br />