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2004-05-12 CC Meeting
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2004-05-12 CC Meeting
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<br />,," " <br /> <br />SUBMIT TO STATE PRIMACY AGENCY <br />(The State Drinking Water Program Office) <br /> <br />April 07. 2004 <br />Certification of Completion <br /> <br />A final step in completing the Vulnerability Assessment is to notify the state drinking water primacy <br />agency that the assessment has been conducted. Please fill in the following information and send <br />this page only to the appropriate state drinking water primacy agency contact so that this certification <br />can be included in the records that the state maintains on your water sYj;tem. <br /> <br />. <br /> <br />DO NOT send the completed vulnerability assessment 01A) to your state primacy agency unless <br />your State requires VA submittals. <br /> <br />. <br /> <br />DO send the completed VA to the U.S. EPA by June 30, 2004 (if your system serves between <br />3,300 and 50,000 people) to satisfy the requirements of the federal Bioterrorism Act. You must <br />also certify to the U.S. EPA that you have developed or updated your emergency response plan <br />baSed on your VA within six months of submitting your VA to the U.S. EPA The Agency has <br />released gUidelines regarding the proper protocol to follow when submitting your VA. After you <br />have logged onto www.vulnerabilitvassessment.ora you will receive explicit instructions based on <br />the EPA protocols regarding the proper procedure to submit your V/!:s to the U.S. EPA. <br /> <br />System Information <br /> <br />Public Water System (PWS) 10 Number: <br />System Name: Centerville <br />Address: Clo City Clerk <br /> <br />MN1020036 <br /> <br />City: Centervllle <br />State: MN <br />Zip: 55038 <br />Phone: 651-429-4750 <br />Fax: 651-429-8629 <br /> <br />Completed By: Paul Palzer <br />Title: Public Works DlrectorlBullding OfficIal <br />Area of ResponSibility: all <br />Phone: 651-429-4750 <br />Fax: 651-429-8629 <br />Email: ppalzer@centervlllemn.com <br /> <br />24 Hour Emergency Contact Information <br /> <br />Contact Name: Paul Palzer <br />Daytime Phone: 651-429-4750 <br />Emergency Phone: 762-427-1212 <br />Cell Phone: 651-261-5733 <br />Fax Number: 651-429-8629 <br />Emergency Email: ppalzer@centervlllemn.com <br /> <br />The information in my vulnerability assessment has been completed to the best of my <br />knowledge. <br /> <br />Signed <br /> <br />Date <br />
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