Lead Consumer Notice Certification Form - WV DHHR - wvdhhr 2025

1. Click ‘Get Form’ to open the Lead Consumer Notice Certification Form in the editor.
2. Begin by entering the System Name and PWSID No. in the designated fields at the top of the form.
3. Fill in the County where the water system operates, ensuring accuracy for proper documentation.
4. Specify the Monitoring Period applicable to this notice, such as 'June – Sept. 2009', in the provided section.
5. Input the Date(s) results were received from the laboratory and Date(s) results were provided to consumers in their respective fields.
6. Certify that you have provided lead consumer notice by filling out your name, title, phone number, and date at the bottom of the form.
7. If applicable, check any additional distribution methods used for notifying consumers about lead exposure and provide details as necessary.

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