LARGE WATER SYSTEM
2019 ANNUAL REPORT TO THE DRINKING WATER PROGRAM
FOR YEAR ENDING DECEMBER 31, 2019
[Section 116530 Health & Safety Code]

WATER SYSTEM INFORMATION
Water System No.:
Water System Name:
Water System Ownership (See descriptions below):	--Pick one-- Local Government State or Federal Government Privately owned, PUC-regulated, for profit water company Privately owned, non-PUC-regulated (Community Water System) Privately owned Mutual Water Company or Association Privately owned business (non-community)
Physical location:   (address line 1, address line 2, city, zip) Note: NO P.O. Box	Zip must be 99999 or 99999-9999
General Office Phone: (with area code)	This must be a phone number (999) 999-9999
Web site address:

BOXES COLORED YELLOW ARE MANDATORY QUESTIONS AND MUST BE ANSWERED TO COMPLETE THIS REPORT

Water System Ownership Descriptions:

• Local Government: e.g., city, county, or special district, local school district, junior colleges, county or community parks, etc.
• State or Federal Government: e.g., state or national park, BLM, USFS and COE campgrounds and recreation facilities,
  state hospitals, State universities and colleges, California Veterans Home, County or District Fairs and Expositions,
  Caltrans rest stop, military base, other state or federal facility
• Privately owned, non-PUC-regulated (Community Water System): e.g., mobile home park, apartment or condominium
• Privately owned business (non-community): e.g., church, private school, restaurant, amusement park, RV park/campground,
  motel, ranch/farm, factory, other business establishment

COMMUNITY WATER SYSTEMS ONLY

Your water system classification is:  

IF YOU ARE NOT A COMMUNITY WATER SYSTEM, SKIP THIS SECTION

CERTIFICATION FOR REDUCTION OF ANNUAL FEES FOR PUBLIC WATER SYSTEMS SERVING A DISADVANTAGED COMMUNITY (DAC)

By checking this box, you are a community water system who would like to request a fee reduction and is serving a DAC as defined in Title 22, Division 4, Chapter 14.5, section 64300 of the California Code of Regulations OR has previously submitted documentation to the State Water Resource Control Board certifying that you are serving a DAC.

To request a DAC fee reduction or to continue receiving a reduced annual fee you must complete a DAC certification form and upload the form to the “DAC” tab for the State Water Resources Control Board to review.

Click HERE for instructions on how to upload your completed DAC certification form. To upload a DAC Certification Form, click HERE

If you have questions about completing this section of the report, please contact the Program Liaison Unit at DDW-PLU@waterboards.ca.gov or call (916) 449-5158.

REPORT SUBMITTED BY:
Note: Your name and title, email address, and work phone number are disclosable report information that may be obtained through the Public Records Act.
Name:
Title:
Work phone:
Cell phone:
Email address:

Please be aware that all comment boxes throughout this electronic annual report will be made publicly available WITH THE EXCEPTION of the comment box below. Only Waterboard staff and other people with your water system’s DRINC login credentials will have access to this comment box. You are encouraged to provide any comments that you believe may help improve this annual report process.

PRIVATE COMMENTS:

1. Public Water System Contacts

Click here to learn how to Modify, Add and Delete Contacts in the table below.

IMPORTANT: Each water system must have one and only one Administrative Contact AND one and only one Financial Contact. The same person may be both the Administrative and Financial Contacts.

Please provide an email address for the Administrative Contact as most email communication, particularly email blasts, from the Division of Drinking Water will be sent to the email address of the Administrative Contact.
PHONE TYPE: Home – if you use your home or personal phone number as your business number, use the HOME phone type instead and leave the BUSINESS phone type blank.
Only the BUSINESS phone type will appear in Drinking Water Watch (https://sdwis.waterboards.ca.gov/PDWW/), which can be viewed by the public, if the General Office phone number is not provided (see Water System Information section under the Intro tab).

EXISTING CONTACTS
NAME, TITLE & ADDRESS			PHONE TYPE	PHONE NO.	EMAIL	CONTACT TYPE (pick all that apply)
			Business Home	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999	This must be an email address This must be an email address	** Delete Contact ** Administrative	Operator
			Facsimile	This must be a phone number (999) 999-9999		Financial	Emergency
			Mobile	This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
			Business Home	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999	This must be an email address This must be an email address	** Delete Contact ** Administrative	Operator
			Facsimile	This must be a phone number (999) 999-9999		Financial	Emergency
			Mobile	This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
			Business Home	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999	This must be an email address This must be an email address	** Delete Contact ** Administrative	Operator
			Facsimile	This must be a phone number (999) 999-9999		Financial	Emergency
			Mobile	This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
			Business Home	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999	This must be an email address This must be an email address	** Delete Contact ** Administrative	Operator
			Facsimile	This must be a phone number (999) 999-9999		Financial	Emergency
			Mobile	This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
			Business Home	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999	This must be an email address This must be an email address	** Delete Contact ** Administrative	Operator
			Facsimile	This must be a phone number (999) 999-9999		Financial	Emergency
			Mobile	This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
			Business Home	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999	This must be an email address This must be an email address	** Delete Contact ** Administrative	Operator
			Facsimile	This must be a phone number (999) 999-9999		Financial	Emergency
			Mobile	This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
			Business Home	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999	This must be an email address This must be an email address	** Delete Contact ** Administrative	Operator
			Facsimile	This must be a phone number (999) 999-9999		Financial	Emergency
			Mobile	This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
			Business Home	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999	This must be an email address This must be an email address	** Delete Contact ** Administrative	Operator
			Facsimile	This must be a phone number (999) 999-9999		Financial	Emergency
			Mobile	This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
NEW CONTACTS
Add Additional Contact						(pick all that apply)
			Business	This must be a phone number (999) 999-9999	This must be an email address This must be an email address	Administrative	Operator
			Home	This must be a phone number (999) 999-9999		Financial	Emergency
			Facsimile Mobile	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
Add Additional Contact						(pick all that apply)
			Business	This must be a phone number (999) 999-9999	This must be an email address This must be an email address	Administrative	Operator
			Home	This must be a phone number (999) 999-9999		Financial	Emergency
			Facsimile Mobile	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
Add Additional Contact						(pick all that apply)
			Business	This must be a phone number (999) 999-9999	This must be an email address This must be an email address	Administrative	Operator
			Home	This must be a phone number (999) 999-9999		Financial	Emergency
			Facsimile Mobile	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator
Add Additional Contact						(pick all that apply)
			Business	This must be a phone number (999) 999-9999	This must be an email address This must be an email address	Administrative	Operator
			Home	This must be a phone number (999) 999-9999		Financial	Emergency
			Facsimile Mobile	This must be a phone number (999) 999-9999 This must be a phone number (999) 999-9999		Designated Operator In Charge	Water Quality
Zip must be 99999 or 99999-9999			Emergency	This must be a phone number (999) 999-9999		Owner	Legal
						Funding	Contract Operator

COMMENTS (Note: Comments will be made publicly available):

2. POPULATION SERVED

Permanent population or number of long-term residents*:

This must be a whole number without commas

*Long-term resident means someone who resides within the water system service area for more than half of the year.

Method used to determine population:

--Pick one-- Most recent United States census data Multiplied number of service connections by 3.3 Determined total number of dwelling units and multiplied by 2.8 Other

If permanent population is based on "Other" , identify the methods or sources of how it was estimated::

Seasonal Maximum Population (If applicable):

This must be a whole number without commas

Provide season :

Begin Date		End Date
MM	DD	MM	DD
Month must be between 1 and 12This must be a 2 digit month	Day must be between 1 and 31This must be a 2 digit day	Month must be between 1 and 12This must be a 2 digit month	Day must be between 1 and 31This must be a 2 digit day

List the names of communities served by the system identifying both incorporated and unincorporated areas:

COMMENTS (Note: Comments will be made publicly available):

3. NUMBER OF SERVICE CONNECTIONS (as of December 31, 2019)

A. Active Service Connections:

Total Active Potable Water Connections currently in Division of Drinking Water database:

The total number of Service Connections as of December 31, 2019 must be reported as either Unmetered or Metered for each Service Connection Type as appropriate.

	Potable Water
TYPE Do NOT report fire sprinkler connections and fire hydrants. These connections are not counted toward “service connections” for compliance purposes.	Unmetered	Metered	Total*
Single-family Residential: single family detached dwellings	This must be a whole number without commas	This must be a whole number without commas
Multi-family Residential: Apartments, condominiums, town houses, duplexes and trailer parks	This must be a whole number without commas	This must be a whole number without commas
Commercial/Institutional: Retail establishments, office buildings, laundries, schools, prisons, hospitals, dormitories, nursing homes, hotels, churches, campgrounds	This must be a whole number without commas	This must be a whole number without commas
Industrial: All manufacturing	This must be a whole number without commas	This must be a whole number without commas
Landscape Irrigation: Parks, play fields, cemeteries, median strips, golf courses	This must be a whole number without commas	This must be a whole number without commas
Agricultural Irrigation: Irrigation of commercially-grown crops	This must be a whole number without commas	This must be a whole number without commas
Total Active Connections*

*Calculated field

If the connection categories below include some portion of residential connections, please check the boxes below:

Commercial/Institutional

Industrial

Landscape Irrigation

B. Number of Inactive Connections (all types) Include only service connections that have been physically disconnected (e.g., meter removed) from the water system. All other service connections should be considered as “Active.”

This must be a whole number without commas

C. Outdoor or Indoor meters/submeter

Only Urban Water Suppliers answer the questions below

Does your water system keep records on outdoor irrigation meters or commercial, institutional, or industrial indoor submeters? --Pick one-- Yes No

If “no”, skip questions C1-C4 in this section and question 6B2 in Section 6B, Deliveries.

C1. Number of NON-residential customers that have dedicated outdoor irrigation meters (excluding agricultural connections)

This must be a whole number without commas

C2. Number of Single-Family Residential customers with dedicated outdoor irrigation meters? This must be a whole number without commas

C3. Number of Multi-Family Residential customers with dedicated outdoor irrigation meters? This must be a whole number without commas

C4. Number of Commercial, Institutional and Industrial customers with indoor submeters? This must be a whole number without commas

COMMENTS (Note: Comments will be made publicly available):

4. GROUNDWATER (GW) AND SURFACE WATER (SW) SOURCES

Type	Total No. Active	Total No. New/ Added in 2019	Total No. Inactivated in 2019	Total No. Destroyed in 2019
Active Groundwater Intakes (Wells)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Active Surface Water Intakes (Raw)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Active Purchased Water (GW) Connections	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Active Purchased Water (SW) Connections	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Standby Sources1	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Emergency Interconnections	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Inactive Sources2	This must be a whole number without commas		This must be a whole number without commas	This must be a whole number without commas

Are your active water sources metered?	--Pick one-- Yes No Some
Do you routinely monitor the static water levels in your wells?	--Pick one-- Yes No Not Applicable (no wells)
Do you routinely monitor the pumping water levels in your wells?	--Pick one-- Yes No Not Applicable (no wells)
Are these levels recovering, declining or steady?:	--Pick one-- Recovering Declining Steady Not Applicable (no wells)

¹If a standby source was used in 2019, provide the following information.

Name of the Standby Source used in 2019:	No. of days the Standby Source was in operation:	Were customers notified? (Y/N)	Was the Division of Drinking Water notified? (Y/N)	Describe the reason the Standby Source was used:
					1 - 4 of 4

²Inactive sources are not approved as sources of supply and must be physically disconnected or similarly isolated.

COMMENTS (Note: Comments will be made publicly available):

5. WATER PRODUCED, PURCHASED AND SOLD

The Maximum Day is the day during 2019 with the highest total water usage. Provide the date for that day in Column B,
then complete Columns C, D and E, indicating how much of the water on that day was from each source.

Important Note Concerning Recycled Water Questions:

The California Water Code Section 10609(c)(4) states: “The state should identify opportunities for streamlined reporting, eliminate redundant data submissions, and incentivize open access to data collected by urban and agricultural water suppliers.”

It has come to the Division of Drinking Water’s attention that, between this Electronic Annual Report and other reports, some public water systems experience (at least some) redundant reporting of recycled water information to the Division of Drinking Water.

If some or all of the quantities are reported elsewhere, check this box: . Answer any questions below that are not reported elsewhere and leave the reported quantities blank in the table. Please note in the comments where these quantities were reported.

Leave recycled water cells blank ONLY IF it is reported elsewhere on other reports indicated below, otherwise enter zero or the actual figure.

Name of report(s) containing the information requested in this Electronic Annual Report for reporting year 2019:

Regulatory entity receiving the report(s), contact name, and phone number:

Units of Measure for tables in Section 5A: --Pick one-- Gallons Thousand Gallons Million Gallons Acre-feet (AF) 100 cubic feet Not applicable

Volumes are based on: --Pick one-- METERED VOLUMES ESTIMATED VOLUMES

Table 5A: Water Produced, Purchased, and Sold

A	B	C	D	E	F	G	H	I
	Potable Water						Non-potable (exclude recycled)6	Recycled7
	Date/ Month	Water Produced from Groundwater (Wells)	Water Produced from Surface Water2	Potable Water Received from another PWS5	Total Amount of Potable Water3*	Water Sold to Another PWS5
Check here if no production for every month
Maximum Day1		This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
January		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
February		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
March		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
April		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
May		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
June		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
July		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
August		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
September		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
October		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
November		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
December		This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas	This must be a number without commas
Annual Total*
Percent Treated4		This must be a number without commas

PWS = Public Water System

^*Calculated field

Non-potable = water supplies, except recycled water, that do not enter the drinking water distribution system and are for non-potable uses only such as irrigation

Recycled = domestic wastewater which as a result of treatment is suitable for uses other than potable use such as irrigation or toilet flushing

¹Only report Maximum Day if it is actually measured or determined from production records. It should not be the average day demand during
the maximum month of production.

²Do not include raw water purchased; report only volume of water that was treated.

³(F) Total Amount of Potable Water = Sum of Columns (C), (D) and (E), automatically calculated. Total water production includes water that is sold to another water system. To update, click below

⁶ Non-potable = water supplies, except recycled water, that do not enter the drinking water distribution system and are for non-potable uses only such as irrigation

⁷ Recycled = domestic wastewater which as a result of treatment is suitable for uses other than potable use such as irrigation or toilet flushing. The recycled water collected in this table should be the non-potable recycled water which is used to substitute potable water or untreated surface and well water. If the recycled were not available, potable or untreated surface and well water needs to be used. Example, a landscape used to be irrigated using potable water but now using recycled water.

⁴This is the percentage of the total annual volume for Groundwater produced that was provided treatment to meet drinking water standards other than precautionary disinfection and fluoridation.

⁵If water was Purchased/received from or Sold/delivered to another PWS, complete the table below:

Specify whether water was Purchased or Sold or Transferred	Name of PWS
		1 - 3 of 3

If recycled water was supplied to your water system’s customers , complete the table below:

Specify the level of treatment (e.g., tertiary, disinfected secondary)	Name of Recycled Water supplier
		1 - 3 of 3

COMMENTS (Note: Comments will be made publicly available):

6. WATER RATES, AFFORDABILITY, AND FINANCES

A. WATER RATES

Does your water system charge customers for water (residential, commercial, industrial, or institutional water customers)? --Pick one-- Yes No

If yes, complete Section 6A. If no, explain why: --Pick One-- Supplier is an educational facility with its own water source Supplier is an institutional facility with its own water source Supplier is a business with its own water source Supplier is a park or recreational facility with its own water source Supplier is a wholesaler Other, (explain in comment box below)

If you have questions about completing this section of the report, please contact Mary.Yang@Waterboards.ca.gov, 916-322-6507

A1. RESIDENTIAL WATER RATES

Complete this section if you have residential water rates. If no, mark this box: and go to Section A6, Non-residential Water Rates.

If you are a water supplier without water rates, check this box , then move to Section 6B Water Deliveries.

A1.a. Indicate the type of residential water rate structure used by your water system (select those that apply):

Base Rate – (Non-Volumetric Rates)

Fixed Base Rate - Basic or fixed charge that is the same for all customers regardless of use.

Variable Base Rate - Basic charge is different for customers depending on size of pipe, water meter, elevation, peak use, or other factors.

Usage Rate (Volumetric Rates)

Uniform Usage Rate - The charge per 100 cubic feet of water is the same regardless of use.

Variable Usage Rate - Increasing Block or Tier Rate. The charge per 100 cubic feet or other increment of water increases as water use increases.

Other Rates

Flat Rate (often unmetered)- One rate for providing drinking water regardless of the volume of water used, not combined with a usage rate.

If you have a Flat Rate, please skip questions A1.d, A1.e, A1.g, A1.h. Enter your flat rate in A3.

Allocation Based

Other rate structure (specify your rate structure in the comment box, provide a weblink 1j below)

A1.b. Comments on rate structure (Note: Comments will be made publicly available):

A1.c. What is your billing frequency?	--Pick one-- monthly bi-monthly quarterly annually other
A1.d. If charges change with different levels of water consumption or features, what is the number of tiers or levels of charges for single-family customers?	--Pick one-- Not Tiered 2 3 4 5 6 7
A1.e. If charges change with different levels of water consumption or features, what is the number of tiers or levels of charges for multi-family customers?	--Pick one-- Not Tiered 2 3 4 5 6 7
A1.f. Mark below any variances or factors used to determine or adjust residential water rates or water allocations.
Agricultural use (non-commercial or commercial)
Drought factor
Elevation
Evaporative Coolers
Fire protection - water to irrigate vegetation
Home-based business
Livestock or large animals
Lot size
Medical needs
Meter size
Mitigation of high levels of total dissolved solids
Occupancy (All-year)
Occupancy (Seasonal)
Pressure zone
Soil compaction and dust control
Supplement ponds and lakes to sustain wildlife
Other :
None of the above
A1.g. Units of Measure (UOM) for this table on Residential Water Rates:	--Pick one-- Gallons (Gal) Hundred Cubic Feet Thousand Gallons Million Gallons Acre Feet Not Applicable

A1.h. Table on Residential Water Rates, Single-family and Multi-family

If your water system uses an allocation or flat base rate structure, add a direct weblink to more information on your rate structure (A1.k or A1.l), provide information in the box “Comments on Residential Rate Structure”(A1.m), and leave this table blank.

	Provide information on residential water rates based on consumption. If a feature of your rate structure, (e.g., meter size, elevation, or other) affects water rates, provide the water rate associated with the most common situation. Enter zero “0” if not applicable. See examples
	Single-family Rates		Multi-family Rates
	Upper volume of water included in base rate in Units of Measure (UOM) If there is no base rate or volume of water associated with a base rate, enter the number zero “0”.	Cost per Billing Period (Dollars)	Upper volume of water included in base rate in Units of Measure (UOM) If there is no base rate or volume of water associated with a base rate, enter the number zero “0”.	Cost per Billing Period (Dollars)
Base Rate (non-volumetric rates)	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas
(Lower level instead of higher level) The rows that follow do not include a base rate or fixed charge. Usage Rate (volumetric rates)	Lower level of water volume for each level in UOM	Cost per UOM (Dollars)	Lower level of water volume for each level in UOM	Cost per UOM (Dollars)
Rate Structure level 1	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas
Rate Structure level 2	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas
Rate Structure level 3	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas
Rate Structure level 4	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas
Rate Structure level 5	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas
Rate Structure level 6	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas
Rate Structure level 7	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas	Number must be between 0.0 and 1000000000.0This must be a number without commas

A1.i. Date of most recent update to the rate structure (this does not include regularly scheduled rate changes, rather actual changes to your rate structure): MM/DD/YYYY	This must be a date (e.g. 12/31/2010)
A1.j. Describe the rate structure changes to rate changes that were made in the update:
A1.k. Provide a direct link to a web page that explains water rates and fees, if available.
A1.l. If a webpage with rate information is not available, Send an email (click here) with the document, subject line: PWSID CA_ _ _ _ _ _ _ and Rate Information
A1.m. Comments on Residential Rate Structure. Explain allocation rate, if applicable.

A2. RESIDENTIAL SERVICE CONNECTIONS

A2.a. Select the most common single-family residential meter size:	--Pick one-- 3/4 inch 5/8 inch 1 inch other not applicable
A2.b. Select the most common multi-family residential meter size:	--Pick one-- 1/2 inch 5/8 inch 3/4 inch 1 inch 2 inch other not applicable
A2.c. What is, approximately, the service connection fee for a single-family brand-new construction based on the most common meter size listed above ($)?	This must be a number without commas
A2.d. Date of most recent update to the new connection fee for a single-family brand-new construction: MM/DD/YYYY	This must be a date (e.g. 12/31/2010)
A2.e. What is the one-time fee or deposit needed to create a new water service account for an existing single-family home based on the most common meter size indicated above ($)?	This must be a number without commas
A2.f. What is, approximately, the connection fee for a multi-family brand-new construction based on the most common meter size indicated above ($)?	This must be a number without commas

A2.g. Check items included in new residential connection fees:

	Existing infrastructure buy-in (e.g., water treatment/ conveyance/sewage treatment )
	Upgrades to infrastructure (seismic retrofits, pipe replacements, etc.)
	Storm water management system
	Debt service charge
	Development of new water supplies
	Other :

A2.h. Comments on Residential Service Connections (publicly available):

A3. AFFORDABLE DRINKING WATER

For each amount of water delivered to a single-family residential customer shown below, what is charged (in dollars) to a customer?

For each of the three water volumes shown below, provide what would be the monthly water bill for a single-family residential customer. Enter the monthly Water Charges and Other Charges for each water volume. For example, if a single-family customer used 12 HCF in a month, the total bill would include water charges for using 12 HCF and other charges that are added to the bill. Other charges vary locally and may include property tax, city tax, utility users tax, services for fire suppression, waste water or sewer, stormwater or other non-water surcharges, electricity. If the “other charges” varies by certain features (e.g., by climate, lot size, landscaped area) use the lowest or most common charge in your calculation. Click the “Update Totals” button to automatically add the charges together to show a Total Monthly Water Bill that a residential customer would pay when its household used the specified amount of water.

For water systems with an allocation rate (also called “budget rates”) see additional guidance

To be consistent with California’s Human Right to Water Law and Conservation Law, the questions in this section ask for water charges associated with 6, 9, 12 and 24 hundred cubic feet (HCF) of water. Information on 9 HCF is new.

A3.a. 6 HCF
Drinking Water Charges (Fixed and variable water charges)	This must be a number without commas	Dollars/month
Other Charges (e.g., property tax, fire suppression, waste water, other)	This must be a number without commas	Dollars/month
Total Monthly Water Bill (Automatic sum of Water Charges and Other Charges)*		Dollars/month
A3.b. 9 HCF
Drinking Water Charges (Fixed and variable water charges)	This must be a number without commas	Dollars/month
Other Charges (e.g., property tax, fire suppression, waste water, other)	This must be a number without commas	Dollars/month
Total Monthly Water Bill (Automatic sum of Water Charges and Other Charges)*		Dollars/month
A3.b. 12 HCF
Drinking Water Charges (Fixed and variable water charges)	This must be a number without commas	Dollars/month
Other Charges (e.g., property tax, fire suppression, waste water, other)	This must be a number without commas	Dollars/month
Total Monthly Water Bill (Automatic sum of Water Charges and Other Charges)*		Dollars/month
A3.c. 24 HCF
Drinking Water Charges (Fixed and variable water charges)	This must be a number without commas	Dollars/month
Other Charges (e.g., property tax, fire suppression, waste water, other)	This must be a number without commas	Dollars/month
Total Monthly Water Bill (Automatic sum of Water Charges and Other Charges)*		Dollars/month

*If “Other Charges” varies, (e.g., by climate, lot size, landscaped area, or other features) use the lowest charge in your calculation.

Calculated field: To update calculated field, click button below

A3.e. Describe what is included in “Other Charges” (mark those that apply).

A3.f. Comments on Affordable Drinking Water (publicly available):

A4. SHUT-OFFS

Completing this section will fulfill State Water Resources Control Board requirements of Senate Bill 998 – Discontinuation of residential water service, which are mandatory as of April 1, 2020.

Click the “Update Totals” button to automatically add the Single Family and Multifamily Accounts

Community Water Systems that have water rates and more than 200 connections must complete this section. If your community water system does not meet these criteria for completing this Section, then you must mark the boxes “did not collect information” below in order to avoid completion errors.

If a water supplier tracks the number of services connections but did not collect information on whether residences were occupied or unoccupied at the time of disconnection, put the total number of disconnections in the “unknown accounts” column in the tables in this section.
If a water supplier does not differentiate between single-family or multi-family, then enter all information as single-family.

Click the “Update Totals” button to automatically sum the Single Family and Multifamily Accounts.

For section A4, select the reporting year for your answers : --Pick one-- Calendar Year (Jan-Dec 2019) Fiscal Year (July 2018-June 2019) Other Not applicable

Residential Shut-offs and Reconnections

A4. This section has several questions on water services. Are you able to provide information on drinking water services alone, or are water services combined with non-water services (e.g., electricity, trash removal services) so your responses cover more than just water services? --Pick one-- Information for water services only Information for Combined Services (water and electricity or other non-water services)

A4.a.How many accounts for residential service connections had their water shut off once during the year due to failure to pay?

If this information is only available for accounts that had their water shut off at least once, then check this box and complete the table below and skip question A4.c

If there was no information collected for question A4.a, then mark this check box and skip below table.

	Occupied Accounts	Unoccupied Accounts	Unknown Accounts	Total*
Single-Family Accounts	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Multi-family Accounts	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas

A4.b. What is the average amount owed at the time of shut-off? $ This must be a whole number without commas Mark the box if unknown

A4.c. How many accounts for residential service connections had their water shut off more than once during the year due to failure to pay?

If there was no information collected for question A4.c, mark this box and skip below table.

	Occupied Accounts	Unoccupied Accounts	Unknown Accounts	Total*
Single-Family Accounts	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Multi-Family Accounts	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas

A4.d. What is the residential fee, including all administrative and processing fees, to restore drinking water service due to failure to pay during operating hours?

Single-Family Accounts	This must be a whole number without commas
Multi-family Accounts	This must be a whole number without commas

A4.e. What is the residential fee, including all administrative and processing fees, to restore drinking water service due to failure to pay during non-operating hours?

Single-Family Accounts	This must be a whole number without commas
Multi-Family Accounts	This must be a whole number without commas

A4.f. What was the median duration of the shut-offs (in days) for continuously occupied residential service accounts?

If there was no information collected for question A4.f, mark the check box “Did not collect median duration of shut-offs (in days) for occupied residents" and skip below table.

	Occupied Accounts	Unoccupied Accounts	Unknown Accounts
Single-Family Accounts	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Multi-Family Accounts	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas

A 4.g How many of these shut-offs are returned to service within one-day (or 24-hours)? This must be a whole number without commas
This answer covers: --Pick one-- Single family Multi-family Single and multi-family

A4.h. If you offer an extended repayment or other customer payment assistance plan, how many continuously occupied residential customer accounts participated?

Single-Family Accounts	This must be a whole number without commas
Multi-family Accounts	This must be a whole number without commas
Total*

A4.i. How many of the continuously occupied residential accounts were shut off at least once during the year and were enrolled in an extended repayment plan or other customer payment assistance plan at the time of the service disconnection?

Single-Family Accounts	This must be a whole number without commas
Multi-family Accounts	This must be a whole number without commas
Total*

*Calculated field, to update calculated fields in this section, click button below

The Water Shutoff Protection Act (SB 998, 2018) requires community water systems that have more than 200 connections to have shutoff policies completed by April 1, 2020. Mark this box if your water system has less than 200 service connections

A4.j Provide a direct weblink to your shutoff policy as required by the Water Shutoff Protection Act:
If your water agency doesn’t have a website and for this reason is unable to post your shutoff policy, email your shutoff policy. Send an email (click here) with the document, Subject line: PWSID CA_ _ _ _ _ _ _ and Shutoff Policy

A4.k. What is the number of residential accounts (single-family, multi-family, and mixed use that include residential) that were missing one or more required water bill payments at the end of your year? This must be a whole number without commas

A4.l. For A4.k accounts, what is the sum of outstanding uncollected residential (single-family, multi-family, and mixed use that include residential) bills at the end of your most recent year? This must be a whole number without commas Not determined

A4.m. Comments on Shut-offs (publicly available):

A5. Affordable Drinking Water Assistance

For section A5, select the reporting year for your answers : --Pick one-- Calendar Year (Jan-Dec 2019) Fiscal Year (July 2018-June 2019) Other Not applicable

A5.a. Do you provide options for low-income assistance? If you selected “No”, skip questions A5b-A5h.	--Pick one-- Yes No
A5.b. If yes, how many residential accounts received the low-income subsidy?	This must be a whole number without commas
A5.c. If yes, how was the program funded?
A5.d. How much funding was allocated to the program in 2019?	This must be a whole number without commas

A5.e Does your program provide benefits to single-family only, or single-family and multi-family? (select answer) --Pick one-- Single-family customers only Single-family and Multi-family customers

A5.f. What was the average benefit amount for a single-family account in one month?
Amount and Unit of Measure: This must be a whole number without commas --Pick one-- Dollars Percentage of Bill Volume

A5g. What was the average benefit amount for a multi-family account in one month?
Amount and Unit of Measure: This must be a whole number without commas --Pick one-- Dollars Percentage of Bill Volume

A5.h If your system partners with an outside entity (e.g., United Way) to provide assistance to low income households, list the name of organization(s) and the amount of the benefit (in dollars) provided
Dollars provided: This must be a whole number without commas Time Period: --Pick one-- Monthly Bimonthly Annually Other Not Applicable

A5.i. OTHER FORMS OF ASSISTANCE TO ALL RESIDENTIAL CUSTOMERS. What type of bill assistance was provided? (Check all that are applicable)

Flexible or alterative Payment Terms	Number of Accounts This must be a whole number without commas	Average Bill $ This must be a whole number without commas	Information Not Collected or Not Offered
Temporary Assistance	Number of Accounts This must be a whole number without commas	Average Bill $ This must be a whole number without commas	Information Not Collected or Not Offered
Special Medical Need	Number of Accounts This must be a whole number without commas	Average Bill $ This must be a whole number without commas	Information Not Collected or Not Offered
Other Please describe:	Number of Accounts This must be a whole number without commas	Average Bill $ This must be a whole number without commas

A5.j Do you have a process that can offer bill forgiveness under certain circumstance? --Pick one-- Yes No

If yes, Number of Accounts This must be a whole number without commas Average Bill $ This must be a whole number without commas Information Not Collected

A5.k Comments on Affordable Drinking Water Assistance (publicly available):

A6. NON-RESIDENTIAL WATER RATES

If you have non-residential water rates, complete this section. If no, mark this box: and go to Section 6B, Deliveries

A6.a. Select the most common non-residential meter size: --Pick one-- 3/4 inch 5/8 inch 1 inch 1.5 inch 2 inch other not applicable

A6.b. What is your billing frequency for non-residential customers? --Pick one-- monthly bi-monthly quarterly annually other

A6. c. Does your water system use an allocation rate for non-residential accounts? --Pick one-- Yes No
If yes, skip table A6d. In the comment box A6.e provide a weblink to more information on the allocation rates.

A6.d. Complete the table below providing specific water rates applied to your non-residential customers:

Connection Type	BASE RATE (BR)	If BR + UUR, what is the volume allowed before UUR applies	UNIFORM USAGE RATE (UUR)	VARIABLE BASE RATE (provide range) (VBR)		VARIABLE USAGE RATE (provide range) (VUR)
	$ (Base)	HCF	$ per HCF	$ Low	$ High	$ per HCF Low	$ per HCF High
Commercial	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas
Institutional	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas
Industrial	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas
Landscape Irrigation	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas
Agricultural Irrigation	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas
Other	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas

A6.e Comments on non-residential water rates (publicly available):

B. WATER DELIVERIES

Check this box if your water system does not have monthly water deliveries data and skip the rest of Section B.

Important Note Concerning Recycled Water Questions:

The California Water Code Section 10609(c)(4) states: “The state should identify opportunities for streamlined reporting, eliminate redundant data submissions, and incentivize open access to data collected by urban and agricultural water suppliers.”

It has come to the Division of Drinking Water’s attention that, between this Electronic Annual Report and other reports, some public water systems experience (at least some) redundant reporting of recycled water information to the Division of Drinking Water.

If some or all of the quantities are reported elsewhere, check this box: . Answer any questions below that are not reported elsewhere and leave the reported quantities blank in the table. Please note in the comments where these quantities were reported.

Leave recycled water cells blank ONLY IF it is reported elsewhere on other reports indicated above, otherwise enter zero or the actual figure.

Name of report(s) containing the information requested in this Electronic Annual Report for reporting year 2019:

Regulatory entity receiving the report(s), contact name, and phone number:

Units of Measure (UOM) for this table: --Pick one-- Gallons Million Gallons Acre-feet (AF) 100 cubic feet Not applicable

Provide monthly metered water deliveries for all water sources (potable and non-potable) in the table below. If you have partially metered or unmetered water deliveries, check the help tips for additional guidance as you may be able to provide information.

Table 6B Water Deliveries Before you begin, make sure that the water volume values entered in Section 5A Water Supplied and Section 6B Water Deliveries are consistent with each other and that they refer to the same population from Section 2 Population (“permanent population of number of long-term residents”).

A	B	C	D	E	F	G	H	I	J
	Single-family Residential	Multi-family Residential	Commercial/ Institutional	Industrial	Landscape Irrigation	Other	Total Retail1*	Agricultural	Other PWS2
Check if no water is delivered or not applicable
January	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
February	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
March	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
April	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
May	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
June	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
July	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
August	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
September	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
October	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
November	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
December	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas
Annual % recycled water	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas
Annual % non-potable water	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas	This must be a number without commas		This must be a number without commas	This must be a number without commas
Total*

PWS = Public Water System

^*Calculated field

¹Total Retail = Sum of Columns (B) thru (G), automatically calculated. To update, click below

² "Other PWS" values are prefilled from the Section 5 Table, Column G

B1. Mark boxes below:

If the delivery categories below include some portion of residential deliveries, please check the boxes below:

Commercial/Institutional

Industrial

Landscape Irrigation

If you have questions about this please contact State Water Board staff by email at: waterconservation@waterboards.ca.gov. This information is being asked at this time to help staff estimate the impacts of SB 606 and AB 1668, as required for the regulatory process.

Only answer question B2 if your system is an Urban Water Supplier with dedicated outdoor irrigation meters

B2. What is the annual volume of outdoor irrigation water used on landscape areas with dedicated irrigation meters in connection with commercial, institutional, and industrial (CII) water use?

a. Unit of Measure --Pick one-- Gallons Million Gallons Acre-feet (AF) 100 cubic feet Not applicable

b. Volume of water This must be a number without commas

c. Water system does not collect this information (mark box if applies)

Comments

B3. If known, indicate what percentage of total annual urban water deliveries (see column H in Table 6B) is used for irrigation of:

a. Developed and natural parklands This must be a whole number without commas

b. Publicly maintained urban trees (outside of parklands) This must be a whole number without commas

c. Water system does not collect this information (mark box if applies)

COMMENTS (Note: Comments will be made publicly available):

7. WATER QUALITY

Date of Emergency Notification Plan:	This must be a date (e.g. 12/31/2010)
Is the Emergency Notification Plan up to date?	--Pick one-- Yes No If no is selected, please upload a revised WQENP.

DIRECT ADDITIVES

Pursuant to Section 64590, Title 22 of the California Code of Regulations, (effective January 1, 1994), all chemicals or products, including chlorine,
added directly to the drinking water as part of a treatment process must meet the ANSI/NSF Standard 60. Please complete the following table
for each chemical used by this water system. If you are not sure whether a chemical you are using meets this standard, contact the manufacturer
or distributor of the chemical.

If you do not use any direct additives, put “NONE” in each column of the first row.

Name of Chemical	Name of Manufacturer	Purpose of using chemical	Chemical is ANSI/NSF Standard 60 certified (Y/N)	Use initiated in 2019 (Y/N)
					1 - 4 of 4

INDIRECT ADDITIVES

As of March 9, 2008, a water system shall not use any chemical, material, lubricant, or product in the production, treatment or distribution
of drinking water that comes in contact with the drinking water that does not have certification of meeting NSF/ANSI standard 61.

Does your water system have procedures to ensure all future equipment and materials meet this standard?

--Pick one-- Yes No

If you have any questions on the requirements related to indirect additives, you may contact your local regulatory agency.

COMMENTS (Note: Comments will be made publicly available):

8. CROSS-CONNECTION CONTROL

	Total Number in System in 2019 ¹	Number Installed in 2019	Number Tested in 2019 ²	Number Failed in 2019	Number Repaired/ Replaced
Backflow Assemblies on the Service Connections or Meter (Reduced Pressure Principle and Double Check Valve assemblies)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Backflow Assemblies On- site but not on the Service Connections or Meter (Reduced Pressure Principle and Double Check Valve assemblies)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Air-gap Separation	This must be a whole number without commas	This must be a whole number without commas

Notes:

¹ Total Number in System in 2019 – Total number of active Backflow Prevention Assemblies including new devices installed in 2019, but excluding inactive devices.
² Number Tested in 2019 – includes all active devices that were tested in 2019 and either passed or failed.

No. of Inactive Backflow Prevention Assemblies in water system in 2019 :			This must be a whole number without commas
Date of last cross-connection control survey done on the system: If ongoing, enter the last day of the year, e.g., 12/31/2019			This must be a date (e.g. 12/31/2010)
Cross Connection Control Program Coordinator
Name:
Certification Number:
Business Phone:	This must be a phone number (999) 999-9999	Email Address:	This must be an email address
Certification or training received:

Describe any cross-connection incidents that occurred during 2019:

COMMENTS (Note: Comments will be made publicly available):

9. OPERATOR CERTIFICATION

A. Please list the State certified Water Treatment Plant Operators employed by your water system that supervise and direct the operation
of your water treatment plants, beginning with the chief operator(s) .

Your Highest Treatment System Classification is:  

Check this box if your public water system has designated a Chief Treatment Operator.

Name of Chief Treatment Operator (First name Last name):
Grade of Chief Treatment Operator (1, 2, 3, 4 or 5):	This must be a whole number without commas
Treatment Operator Number (4 or 5 digits):	This must be a whole number without commas
Treatment Certification Expiration Date (MM/DD/YYYY):	This must be a date (e.g. 12/31/2010)

Treatment Operator Name (First name Last name)	Grade of Treatment Operator (1, 2, 3, 4, or 5)	Chief or Shift1 (C, S or X)	Treatment Operator Number (4 or 5 digits)	Treatment Certification Expiration Date (MM/DD/YYYY)
					1 - 4 of 4

¹Use “C” for Chief Operator and “S” for Shift Operator. If neither, put an "X". Do not leave blank.

Do your Chief and Shift Treatment Plant Operators have the minimum level required? --Pick one-- Yes No No treatment facility except precautionary disinfection Don't Know

B. Please list the State certified Water Distribution System Operators employed by your water system that supervise and direct the operation
of your distribution systems, beginning with the chief operator(s) .

Your Distribution System Classification is:  

Check this box if your public water system has designated a Chief Distribution Operator.

Name of Chief Distribution Operator (First name Last name):
Grade of Chief Distribution Operator (1, 2, 3, 4 or 5):	This must be a whole number without commas
Distribution Operator Number (4 or 5 digits):	This must be a whole number without commas
Distribution Certification Expiration Date (MM/DD/YYYY):	This must be a date (e.g. 12/31/2010)

Distribution Operator Name (First name Last name)	Grade of Distribution Operator (1, 2, 3, 4, or 5)	Chief or Shift1 (C, S or X)	Distribution Operator Number (4 or 5 digits)	Distribution Certification Expiration Date (MM/DD/YYYY)
					1 - 4 of 4

¹Use “C” for Chief Operator and “S” for Shift Operator. If neither, put an "X". Do not leave blank.

Do your Chief and Shift Distribution System Operators have the minimum level required? --Pick one-- Yes No Don't Know Not Applicable (transient non-community water system)

COMMENTS (Note: Comments will be made publicly available):

10. WATER SYSTEM IMPROVEMENTS

The California Waterworks Standards (Section 64556) require an amended permit for any of the following improvements or modifications:

• Addition of a new distribution reservoir with a capacity of 100,000 gallons or more
• Modification or extension of the existing distribution system using an alternative to the requirements of the
  California Waterworks Standards (see Sections 64570 through 64578)
• Modification of the water supply by:
  • Adding a new source
  • Changing the status of an existing source (for example, active to standby) or
  • Changing or altering a source, such that the quality or quantity of water supply could be affected
• Any addition or change in treatment, including
  • Design capacity
  • Process
• Expansion of the existing service area by 20 percent or more of the number of service connections specified in your current permit.

If your water system made any improvements or modifications during 2019 for which a permit was not obtained, please describe
the improvements or modifications below.

Indicate any planned improvements or modifications for 2020.

COMMENTS (Note: Comments will be made publicly available):

11. COMPLAINTS REPORTED (WRITTEN OR VERBAL)

Type of Complaint	No. of Complaints Reported by Customers	No. of Complaints Investigated	No. of Complaints reported to the Division of Drinking Water or Local County Staff	Brief Description of Cause and Corrective Action taken
Taste and Odor	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Color	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Turbidity	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Visible Organisms	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Pressure (High or Low)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Water Outages1	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Illnesses (Waterborne)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Other (Specify)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Total No. of Complaints*

¹These are customer complaints of a water outage and not necessarily the same as the water outages reported under “System Problems” in the Distribution Section of the EARDWP.
*Calculated field

COMMENTS (Note: Comments will be made publicly available):

12. RECYCLED WATER USE

Does your water system have recycled water in its service area (provided by your water system or another utility)? If no, skip the questions below in this section and move to the next section.

--Pick one-- Yes No Don't Know

Important Note Concerning Recycled Water Questions:

The California Water Code Section 10609(c)(4) states: “The state should identify opportunities for streamlined reporting, eliminate redundant data submissions, and incentivize open access to data collected by urban and agricultural water suppliers.”

It has come to the Division of Drinking Water’s attention that there is (at least some) redundant reporting of recycled water information occurring, for at least for some public water systems in this Electronic Annual Report to the Division of Drinking Water. If some or all of the recycled water questions are reported elsewhere, check this box: . Answer any questions below that are not reported elsewhere and leave the reported quantities blank in the table. Please note in the comments where these quantities were reported.

Name of report(s) containing the information requested in this Electronic Annual Report for reporting year 2019:

Regulatory entity receiving the report(s), contact name, and phone number:

If only some of the recycled water questions in this Electronic Annual Report section are reported elsewhere, complete the information above and answer the questions below that are not reported elsewhere. Leave recycled water cells blank ONLY IF it is reported elsewhere on other reports indicated above, otherwise enter zero or the actual figure.

Recycled Water (RW) Use Sites	Total No. of Approved Sites as of Dec. 31, 2019	No. of New Sites Approved in 2019	No. of Sites Proposed for 2020
Irrigation, Agriculture	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Irrigation, Landscape	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Industrial	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Dual-plumbed (In-building)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Dual-plumbed (Single-family lot)	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Cooling Towers	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Other	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Total*

Name of the recycled water coordinator:
Business Phone:	This must be a phone number (999) 999-9999
Email address:	This must be an email address
How many inspections of recycled water use sites were conducted in 2019?	This must be a whole number without commas
How many pressure/shutdown tests were performed in 2019?	This must be a whole number without commas
Do all of your recycled water uses sites have an on-site supervisor?	--Pick one-- Yes No
How many recycled water uses sites do not have an on-site supervisor?	This must be a whole number without commas

COMMENTS (Note: Comments will be made publicly available):

13. SYSTEM OPERATION - TREATMENT

A. GROUNDWATER TREATMENT (respond only if groundwater treatment is provided, exclude chlorination treatment)

Groundwater Treatment Plant Name	Treatment Process	Date of Operations Plan	Is Operations Plan Current? (Y/N)	Contaminant Removed
					1 - 6 of 6

Describe any plant problems, process failures, major shutdowns, etc., which occurred in 2019 and substantially affected the plant performance AND/OR
any significant modifications or maintenance provided to the plant(s):

B. SURFACE WATER TREATMENT (respond only if surface water treatment is provided)

Surface water Treatment Plant Name	Date of Operations Plan	Is Operations Plan Current? (Y/N)
			1 - 6 of 6

Describe any plant problems, process failures, major shutdowns, etc., which occurred in 2019 and substantially affected the plant performance AND/OR
any significant modifications or maintenance provided to the plant(s):

TD = Treatment or Distribution operator at any level

NR, N/A, NA = There are no facilities subject to the Certified Treatment Plant Operator requirements

Date of current Emergency Disinfection Plan (EDP)*:	This must be a date (e.g. 12/31/2010)
*As required under Section 64660(c)(2). The EDP may be included in your water system’s Emergency Response Plan or Operations Plan. If so, provide the Name and Date of those plans below:.
Name of Document that includes the Emergency Disinfection Plan:
Date of document that includes the Emergency Disinfection Plan:	This must be a date (e.g. 12/31/2010)
Date of last watershed sanitary survey report :	This must be a date (e.g. 12/31/2010)
Date planned to complete next watershed sanitary survey report*:	This must be a date (e.g. 12/31/2010)
*As required under Section 64665, each watershed sanitary survey shall be updated at least every 5 years.

COMMENTS (Note: Comments will be made publicly available):

14. SYSTEM OPERATION – DISTRIBUTION

A1. DEAD-END FLUSHING PROGRAM

Total No. in System	No. with Blowoffs	No. Flushed in 2019	Frequency of Flushing
This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas

Comments on DEAD-END FLUSHING PROGRAM (publicly available):

A2. ALL FLUSHING OPERATIONS

Units of Measure for total volume reported below:	--Pick one-- Gallons Million Gallons Acre-feet (AF) 100 cubic feet Not applicable
Total Volume in units of measure selected above; include all types of flushing, not just dead-end flushing:	This must be a number without commas

Comments on ALL FLUSHING OPERATIONS (publicly available):

B. VALVE EXERCISE PROGRAM

Size Range of Valves	Total No. in System	No. Exercised in 2019	Frequency of Valve Exercising
	This must be a whole number without commas	This must be a whole number without commas

Comments on VALVE EXERCISE PROGRAM (publicly available):

C. STORAGE TANK/RESERVOIR INSPECTION/CLEANING PROGRAM

(Do not include pressure tanks)

Tank name	Capacity (in million gallons, MG)	Year installed	Date of last inspection	Date of last cleaning	Date re-lined or coated	Corrosion protection(*)	Material of construction
						--Pick One-- Passive Impressed Current Hybrid None N/A-not metal		1 - 6 of 6
						--Pick One-- Passive Impressed Current Hybrid None N/A-not metal
						--Pick One-- Passive Impressed Current Hybrid None N/A-not metal
						--Pick One-- Passive Impressed Current Hybrid None N/A-not metal
						--Pick One-- Passive Impressed Current Hybrid None N/A-not metal
						--Pick One-- Passive Impressed Current Hybrid None N/A-not metal

*Coatings and linings do not count as corrosion protection for table Subsection C.

D. SYSTEM PROBLEMS

Type of Problem	No. of Problems	No. of Problems Investigated	No. of Problems Reported to the Division of Drinking Water or Local County Staff	Brief Description of Cause and Corrective Action Taken
Service Connection Breaks/ Leaks	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Main Breaks/Leaks	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Water Outages	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Boil Water Orders	This must be a whole number without commas	This must be a whole number without commas	This must be a whole number without commas
Total*

Comments on SYSTEM PROBLEMS (publicly available):

E. INFRASTRUCTURE AND PRESSURE

Pipe Material in Distribution System

1. Which materials does your distribution system pipe consist of? Please check all that apply:

Plastic (Including Poly Vinyl Chloride and HDPE)
Steel
Cast Iron
Galvanized Iron
Ductile Iron
Cement Concrete
Asbestos Cement

Pipeline Material	Percentage of distribution pipe system composed of the materials selected above	Average Age (in years)
Plastic	Number must be between 0.00 and 100.0This must be a number without commas	This must be a number without commas
Steel	Number must be between 0.00 and 100.0This must be a number without commas	This must be a number without commas
Cast Iron	Number must be between 0.00 and 100.0This must be a number without commas	This must be a number without commas
Galvanized Iron	Number must be between 0.00 and 100.0This must be a number without commas	This must be a number without commas
Ductile Iron	Number must be between 0.00 and 100.0This must be a number without commas	This must be a number without commas
Cement Concrete	Number must be between 0.00 and 100.0This must be a number without commas	This must be a number without commas
Asbestos Cement	Number must be between 0.00 and 100.0This must be a number without commas	This must be a number without commas
other:	Number must be between 0.00 and 100.0This must be a number without commas	This must be a number without commas

COMMENTS (Note: Comments will be made publicly available):

15. EMERGENCY PREPAREDNESS & RESPONSE, AND WATER PARTNERSHIPS

A. EMERGENCY RESPONSE PLANS

PUBLIC WATER SYSTEMS WITH AT LEAST 3,300 OR MORE PERSONS SHOULD REVIEW AND REVISE THEIR EMERGENCY
RESPONSE PLAN TO ENSURE THAT THE PLANS ARE SUFFICIENT TO ADDRESS POSSIBLE DISASTER SCENARIOS.

Do you have an Emergency Response Plan (ERP) that addresses the procedures for the restoration of water service for your water system?	--Pick one-- Yes No
Date of your current Emergency Response Plan:	This must be a date (e.g. 12/31/2010)
Date ERP was last exercised with a tabletop or other activity:	This must be a date (e.g. 12/31/2010)

Are you registered in your local energy utility’s Public Safety Power Shutoff notification plan? --Pick one-- Yes No Not applicable

B. AUXILIARY POWER SUPPLY

Does your water system have backup power for:
1. Sources:	--Pick one-- All Some Emergency connection only None Not Applicable
2. Pumping Stations:	--Pick one-- All Some Emergency connection only None Not Applicable
3. Water Treatment Plants:	--Pick one-- All Some Emergency connection only None Not Applicable
If your system has backup power, how many times per year is it exercised?	This must be a whole number without commas
Can your system maintain system pressure in all pressure zones either by backup power or by gravity fed storage during power outages for each of the following number of hours?
24 hours --Pick one-- Yes No Only in some zones
48 hours --Pick one-- Yes No Only in some zones
72 hours --Pick one-- Yes No Only in some zones
Is your backup power system automatic or manual start?:	--Pick one-- Automatic Manual Start Not Applicable

COMMENTS (Note: Comments will be made publicly available):

16. WATER CONSERVATION AND DROUGHT PREPAREDNESS

1. Date of your revised Drought Preparedness Plan or Water Shortage Contingency Plan, if any:	This must be a date (e.g. 12/31/2010)
Water system does not have a current drought or water shortage plan, mark box if applies:
2. Did your water system experience water shortages in 2019?	--Pick one-- Yes No
If yes, please estimate the amount of shortfall in units selected for this section	Volume of water: This must be a number without commas
	Units of Measure: --Pick one-- Gallons (Gal) 100 cubic feet Thousand Gallons Million Gallons Acre-feet Not applicable
3. How many water-shortage response stages are in your drought plan? For “non-applicable”, enter zero.	--Pick one-- 0 1 2 3 4 5 6 7 8+
4. Did drought conditions cause you to activate emergency standby wells in 2019?	--Pick one-- Yes No Not Applicable (no wells)
5. Do you project water shortages in the current calendar year?	--Pick one-- Yes No
6. Does your water system anticipate having to go to mandatory restrictions in the upcoming year?	--Pick one-- Yes No

7. Identify the method your water system uses to discourage excessive water use when in drought, in support of SB 814 (2016) (Check as applicable)

7a. Rate structure (e.g., block tiers, water budgets, or rate surcharges above base rates for excessive water use)

7b. Excessive water use ordinance, rule, or tariff condition

7c. Not implementing

7d. Not applicable: not an urban retail water supplier

7e. COMMENTS REGARDING SB 814 (Note: Comments will be made publicly available) :

8. To identify data streamlining opportunities, are there other government agencies, aside from the Department of Water Resources, that require reports on the same information found in the Electronic Annual Report? If yes, please describe (include the title of the report, which agency receives it, and the type of information it includes):

Only complete the questions below if you are an Urban Retail Water Supplier

Conservation legislation (AB 1668 and SB 606, 2018) requires that the Department of Water Resources recommend standards to calculate water use objectives (targets representing efficient water use) for each urban retail water supplier. The State Water Board will use those recommendations to adopt regulations in July 2022. The questions below help inform this process.

9. What conservation activities occurred in your service area in 2019?

a. Provide a direct link to a web page that summarizes conservation activities in your service area, if available.

b. If a webpage is not available, send an email (click here) with the document, Subject line: PWSID CA_ _ _ _ _ _ _, Water Conservation Activities

10. Have you tracked how much your water system spent on conservation and efficiency programs in the last fiscal year? --Pick one-- Yes No

a. If known, enter those expenditures $ This must be a whole number without commas

b. If detailed in a document, provide a direct link to a web page with information:

11. Have you tracked how much water was saved as a result of those programs? --Pick one-- Yes No

a. If known, enter those savings: This must be a number without commas b. Units of measure: --Pick one-- Gallons (Gal) 100 cubic feet Thousand Gallons Million Gallons Acre-feet Not applicable

b. If detailed in a document, provide a direct link to a web page with information:

12. Have you estimated the “saturation” or percentage of water efficient appliances and fixtures already in your service area? --Pick one-- Yes No

a. If yes, provide a direct link to a web page with information:

b. Alternatively, if a webpage is not available, send an email (click here) with the document, Subject line: PWSID CA_ _ _ _ _ _ _ , water efficiency of appliances and fixtures

13. Do you currently use imagery to evaluate demand for outdoor use? --Pick one-- Yes No Comment:

14. Does your water system have a variance or adjustment process that either 1) allows customers to request a greater volume of water than what would otherwise be budgeted for that customer type or 2) signals customers to reduce water use under particular circumstances? For examples of variances and adjustments, see the drop-down boxes below. --Pick one-- Yes No If no, skip this question and go to question 16 below.

a. How many types of adjustments or variances do you provide? This must be a whole number without commas

15. Do you intend to use the potable reuse water bonus incentive explained in CWC 10609.20(d))? --Pick one-- Yes No Maybe

(If you have questions about this please contact State Water Board staff by email at: waterconservation@waterboards.ca.gov. State Water Board staff will follow up with those suppliers who answer “yes”. This information is being asked at this time to help staff estimate the impacts of SB 606 and AB 1668, as required for the regulatory process)

16. COMMENTS (Note: Comments will be made publicly available):

17. CLIMATE CHANGE ADAPTATION AND RESILIENCY FOR WATER UTILITIES

Per Waterboard Resolution 2017-0012, dated 3/7/17, water system inspections are required to address climate change impacts & concerns.

ONLY FOR COMMUNITY WATER SYSTEMS

Your water system classification is:  

If you have questions about completing this section of the report, please contact Joseph.Crisologo@waterboards.ca.gov or call (818) 551-2046.

A. CLIMATE THREATS
What climate-related impacts are of concern for your water system (check all that apply)? Drought Groundwater Depletion Water Quality Degradation Flooding Sea Level Rise Extreme Heat Fire Other None or N/A
B. SENSITIVITY AND MAGNITUDE OF IMPACTS
Qualitatively assess climate change sensitivity of your facilities, and criticality or consequence of disruption. Consider identified climate threats using past experience, and expert judgement based on the magnitude of expected change and extreme events in the future. You do not need numeric answers. USEPA provides a risk assessment tool, called CREAT, to help utilities identify which environmental changes can impact water supply: https://www.epa.gov/crwu/build-resilience-your-utility. More resources are available that may help you complete this section.
Drought | Groundwater Depletion	Decreased water storage (low lake and reservoir levels)	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Groundwater depletion (increased extraction, reduced groundwater recharge, etc.)	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Change in seasonal runoff and/or loss of snowmelt	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Region relies on water diverted from the Delta, imported from the Colorado River, or other climate-sensitive area	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
Water Quality Degradation	Salt-water intrusion into aquifers	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Altered water quality during storm events (turbidity shifts, debris flows)	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Surface water quality issues related to eutrophication, algal blooms, invasive species	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
Flooding | Sea Level Rise	High flow events and flooding	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Inundation due to sea level rise, high tides, and/or coastal storm surges	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Aging flood protection infrastructure (levees), or insufficient impoundment capacity	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
Extreme Heat	Peak demand volume surges (due to extreme heat, temperature trends, etc.)	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Increases in agricultural water demand or energy sector needs	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
Fire | Other Impacts	Increased fire risk and altered vegetation, e.g., wildfires	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Disruption of power supply	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
	Other	Choose an item --Pick one-- High or Already Experiencing Medium Sensitivity None to Low Sensitivity
C. ADAPTATION MEASURES
Identify measures to increase resiliency and reduce vulnerabilities based on identified water system sensitivities. Indicate status for all projects that your organization has completed or plans to implement to increase resiliency of the water system to climate change? Adaptation measures planned or achieved for reasons other than climate change should be put in the “Other” box along with the reason for the measure. USEPA’s Adaptation Strategies Guide for Water Utilities provides examples of adaptation: https://www.epa.gov/crwu/learn-how-plan-extreme-weather-events
Install new and deeper drinking water wells, or modify existing wells to increase pumping capacity		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Develop local supplemental water supply, enhanced treatment, or increased storage capacity (e.g. recycled water, storm runoff for groundwater recharge, desalination, new reservoir)		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Interconnection with other utilities (transfers, mutual aid agreements with neighboring utilities)		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Relocate facilities, construct or install redundant facilities		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Modify facilities (e.g., install barrier or levee, raise a wall, seal a door, elevate construction)		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Conservation measures (demand management, enhanced communication and outreach)		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Fire prevention – brush management, partnerships		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Alternative or backup energy supply		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
On-site energy generation		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Enhance monitoring program, budget for additional testing and treatment, chemicals		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A
Other		Choose an item --Pick one-- Completed In Progress Plan to Implement Will not Implement N/A

COMMENTS (Note: Comments will be made publicly available):

18. LEAD SERVICE LINE REPLACEMENT

ONLY FOR COMMUNITY WATER SYSTEMS

Your water system classification is:  

Section 116885 of the California Health and Safety Code, Lead Service Lines in Public Water Systems, added to the Health and Safety Code by Senate Bill 1398 (2016) and amended by Senate Bill 427 (2017), requires all community water systems (CWSs) to compile an inventory of known partial or total lead user service lines in use in its distribution system by July 1, 2018. DDW is utilizing the electronic annual report (eAR) to gather and update this information.

CWSs that reported in the table below the existence of lead user service lines (A) or unknown material user service lines (B) or lead/unknown fittings associated with user service lines (M or O), need to submit to a timeline for replacement of those user service lines or fittings to DDW by July 1, 2020. Please include the updated information on your user service line inventory below so DDW can track the progress of your system. If you have identified user service lines in A, B, M or O below, you will need to upload a timeline, including a spreadsheet listing the locations and replacement schedules and a letter or short report contain the justification for the dates of the replacement, for approval by DDW. Please utilize the spreadsheet template located on DDW’s lead service line webpage to document the replacement schedules. For the suggested contents of the letter or report, please check the Fact Sheet on DDW’s lead service line webpage. Water systems that previously reported service lines of unknown materials, that have now identified those materials and can certify that no lead or unknown service lines exist, must upload a certification form under the LSLR tab in place of a timeline report or letter.

For additional information including the spreadsheet template, certification form and Facts Sheet, please visit

https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/lead_service_line_inventory_pws.html

If you have questions about completing this section of the report, please contact David.Pimentel@Waterboards.ca.gov or call (916) 323-0572.

IMPORTANT: In the 2017 and 2018 electronic Annual Reports, all CWSs were required to submit the lead service line inventory to the DDW. The inventory will be prefilled with the 2018 EAR data for this section. Please review the table below and take this opportunity to make changes and update your inventory. Do not leave entry spaces blank. You must enter zero in any yellow fields which are not populated, otherwise errors will be generated at the end of the eAR report.

If your water system is a wholesaler and contains no user service lines, you are not required to complete this form: Please check this box:

Date lead service line inventory was completed (MM/DD/YYYY):

This must be a date (e.g. 12/31/2010)

A. User service line inventory:

"User service line" means the pipe, tubing, and fittings connecting a water main to an individual water meter or service connection.

Pipe Material		Estimated Number of Service Lines (Enter “0” if none)	Estimated Total Length of Service Lines (In feet), if applicable
A. Lead		This must be a whole number without commas	This must be a whole number without commas
B. Unknown material		This must be a whole number without commas	This must be a whole number without commas
C. Copper		This must be a whole number without commas
D. Cast iron (ductile pipe)		This must be a whole number without commas
E. Ductile iron		This must be a whole number without commas
F. Galvanized steel		This must be a whole number without commas
G. Polyvinyl chloride (PVC)		This must be a whole number without commas
H. Polyethylene (PE)		This must be a whole number without commas
I. High density polyethylene (HDPE)		This must be a whole number without commas
J. Polybutylene (PB)		This must be a whole number without commas
K. Transite/asbestos cement		This must be a whole number without commas
L. Other materials not listed above:
Identify material 1		This must be a whole number without commas
Identify material 2		This must be a whole number without commas
Identify material 3		This must be a whole number without commas
Identify material 4		This must be a whole number without commas
Total number of service lines inventoried* (calculated field)
Total number of service connections from Section 3 of the EAR		This must be a whole number without commas
Fittings or fittings connecting a water main:
M. Lead fittings NOT on a lead pipe(e.g., goosenecks, pigtails, and corporation stops)		This must be a whole number without commas
N. Lead fittings ON a lead pipe (e.g., goosenecks, pigtails, and corporation stops)		This must be a whole number without commas
O. Fittings of unknown material (e.g., goosenecks, pigtails, and corporation stops)		This must be a whole number without commas
Total number of lead service lines** (calculated field)

*Total number of service lines inventoried (calculated field) = Sum of A through L

**Total number of lead service lines (calculated field) = Sum of A and M

To Update calculated field, click button below

B. Method(s) used to prepare the lead service line inventory in Part A (check all that apply):

Tap Cards or tickets from initial service installation
Plans from water main installation, rehabilitation, and replacement
Records indicating when buildings were constructed
Meter replacement records
Distribution maps, drawings, or GIS
Visual confirmation of pipe material by plumbers or utility crews during maintenance or installation activities
Interviews with water system personnel and/or past employees
Field investigations
Other (describe below):

C. COMPLIANCE WITH LEAD SERVICE LINE REPLACEMENT REQUIREMENT - NEW

Select one of the following options which applies to all community water system:

1. If the CWS completed the requirement by reporting no lead or no unknown service lines or fittings in the 2017, 2018, and 2019 EAR (2017, 2018, and 2019 EAR LSLR inventory table in subsection A. have rows A, B, M and O equal to 0), Check the box below to indicate you have completed the requirement. Click OK in the two pop-up windows that open after the box is checked. No further action is required.

   No lead and no unknown material service lines or fittings.

2. If the CWS reported lead or unknown material service lines or fittings in the 2017 and/or 2018 EAR LSLR section AND have since replaced or identified the materials (2019 EAR LSLR inventory table in subsection A. has rows A, B, M and O equal to 0), complete the LSLR certification form (the template can be found at the webpage linked below) then click HERE to upload the completed form. When you click on the HERE link, a new browser tab will open to the Replacement Timeline LTR or Certification Form upload page, after you have uploaded the document navigate back to this browser tab to complete the Finalize section of the EAR.

   The LSLR certification form template and FAQs can be found on the Lead Service Line Inventory Requirement for Public Water Systems webpage in the Resource and supplemental material section (bottom of page) at: https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/lead_service_line_inventory_pws.html

3. If the CWS reported lead or unknown material service lines or fittings in the 2019 EAR LSLR section (rows A, B, M and/or O are NOT equal to 0), a Replacement Timeline letter and spreadsheet must be submitted. The completed letter and spreadsheet (Replacement Timeline LTR and SS) should be uploaded at the links provided in 3.a. and 3.b. When you click on the HERE link below in 3.a., a new browser tab will open which has the Replacement Timeline LTR upload location, after you have uploaded the document navigate back this browser tab and click the HERE link in 3.b. for a new browser tab to open with the upload page for the Replacement Timeline SS. You will need to return to this browser tab to complete the Finalize section of the EAR after the uploads are completed.

   1. Click HERE to upload the Replacement Timeline LTR
   2. Click HERE to upload the Replacement Timeline SS

   The timeline spreadsheet template and FAQs on this requirement can be found on the Lead Service Line Inventory Requirement for Public Water Systems webpage in the Resource and supplemental material section (bottom of page) at: https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/lead_service_line_inventory_pws.html

If you are not able to upload the Replacement Timeline documents before the 2019 EAR is due, submit the 2019 EAR report on or before the report due date. After the EAR is reviewed, District or LPA Staff will return the EAR for revisions to allow you to upload the required documents by the July 1, 2020 deadline. You can request your District or LPA Office return the EAR for revision if you are ready to upload the documents before the review is completed.

Please indicate the total number of hours spent to complete this report. This information will be utilized to characterize the level of effort required to complete this report This must be a number without commas

By checking this box you acknowledge that any information submitted in this report is publicly accessible and may be used by the State of California to determine compliance with applicable laws and regulations. Knowingly submitting false information in this report is a misdemeanor, and by submitting this information you certify that the contents are, to the best of your knowledge, complete and correct.