Get Lead Verification

This guide provides clear instructions for completing the Lead Verification form online. Understanding each section and field of the form ensures accurate completion and timely submission.

Follow the steps to complete the Lead Verification form.

1. Press the ‘Get Form’ button to retrieve the form and open it for editing.
2. Fill in the Public Water System Name by entering the appropriate name in the designated space.
3. Enter the Public Water System ID Number in the corresponding field to ensure accurate identification of the water system.
4. Indicate the Monitoring Period by specifying the relevant dates to reflect when monitoring occurred.
5. Select the System Type and Method of Delivery by checking the appropriate options as applicable.
6. For date(s) of delivery, indicate the dates when notices were sent either by mail or hand delivery, filling in the spaces provided.
7. If applicable, provide details for Community Systems by entering the delivery location where samples were collected.
8. For Non-transient Non-community or Certain Small Community Systems, post the notice near the locations where samples were taken.
9. For Schools, Day Care Facilities, Nursing Homes, and Juvenile Correctional Institutions, indicate how parents or legal guardians were notified of postings.
10. Complete the section about the Date notices posted, specifying the method used, and entering any relevant dates.
11. Certify that the Consumer Notice was issued by providing the signature of the Responsible Official, their printed name, and their title.
12. Return the completed form via mail, email, or fax, as per the provided instructions.

Complete your Lead Verification form online today to ensure compliance and timely processing.