Public Drinking Water System Update Form
State of Florida
Department of Environmental Protection
|Public Drinking Water System (PWS) Update |
| |
|At least thirty (30) days notice is to be given the Department prior to the proposed sale, or transfer of ownership, of a public water system. 62-555.365, Florida |
|Administrative Code |
|DEP RECORDS CURRENTLY SHOWS THE FOLLOWING: |
|Facility Name & PWS ID No.: | |
|Facility Owner’s Name: | |
|Mailing Address: | |
|Phone & Fax No.: | |
| | |
|Facility Contact or Agent: | |
|Mailing Address: | |
|Phone & Fax No.: | |
| | |
|Licensed Operator’s Name & License No.: | | |
|Mailing Address: | |
|Phone & Fax No.: | |
| | PLEASE INDICATE CHANGES BELOW |
|Facility Name & PWS ID No.: | |
|Facility Address: | |
|Facility Phone & Fax No.: | |
|Email Address: | |
| | |
|Owner’s Name: | |
|Mailing Address: | |
|Phone & Fax No.: | |
|Email Address: | |
|Facility Contact or Agent: | |
|Mailing Address: | |
|Phone & Fax No.: | |
|Email Address: | |
|Licensed Operator’s Name & License No.: | |
|Mailing Address: | |
|Phone & Fax No.: | |
|Email Address: | |
|Property Owner & Phone No.: | |
|Mailing Address: | |
|Effective Date for Changes: | |
|Submitted by: | |
Please complete the Email and/or Fax number fields above, as we have moved to an electronic correspondence system for reminders, inspection reports, and other important advisories. This form is also available online at:
Mail completed form to: DEP Central District By Fax: 407-893-4418
Drinking Water Compliance/Enforcement
3319 Maguire Boulevard, Suite 232
Orlando, Florida 32803-3767
By Fax: 850-412-0482
or via Email to:
DEP_CD@dep.state.fl.us
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