Potential or Proposed Drinking Water System Referral or Request for a Public Water System ID No.
This form is used to notify the Colorado Department of Public Health and Environment’s Water Quality Control Division of potential or proposed water systems that provide access to drinking water to the public. Please note that the person completing the form will NOT receive a copy of or be able to edit the form upon submission, so please review the information carefully before submitting.

Potential water systems are systems that are actively providing water access to the public for human consumption. Per the Environmental Protection Agency, human consumption includes water used for "drinking, bathing, showering, cooking, dishwashing, and maintaining oral hygiene". 

Proposed water systems are systems that are under development and could meet the definition of a public water system when construction is completed. 

The Department will contact the water system to evaluate if it meets the definition of a public water system. Please note that private residences with their own individual private water source should not be referred and do not need to request PWS ID numbers.

This form has 19 questions.

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Email *
Completed by *
First and last name of the person referring the unregistered system or requesting the evaluation.
Organization *
The organization with which the person referring or requesting the evaluation is affiliated.
Phone and/or Email Address
The contact phone number and/or email address of the person referring the unregistered system or requesting the evaluation.
Name of the Facility/Establishment *
PWS ID
Enter the Public Water System Identification Number (PWS ID), if already assigned by the WQCD. This is a six digit number beginning with CO0. If the department has record of the system and assigned a PWS ID you may find the PWS ID on the department's Safe Water Information Finder Tool. You may not have one. If necessary the department will create one for you.
The facility is in which county? *
Facility Address *
Facility Contact Name
Write same if form is completed by the party requesting the evaluation. Can also provide another primary contact.
Facility Contact Phone Number
Write same if form is completed by the party requesting the evaluation. Can also provide another primary contact phone number.
Facility Email
Write same if form is completed by the party requesting the evaluation. Can also provide another primary contact email.
Purpose of the Facility *
Estimated Population Served
Enter average number of people served by the facility per day
What is the drinking water source? *
Identify the existing drinking water treatment *
Required
Is the facility operated year-round?
Clear selection
Is there an immediate regulatory or public health need for drinking water review? *
If there is an immediate public health concern, please provide additional information.
Please provide any other relevant information.
Submit
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