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Notice to Reopen a Small Drinking Water System

This is to notify the Medical Officer of Health of my intention to reopen a small drinking water system in accordance with Ontario Regulation 319/08, Small Drinking Water systems under the Health Protection and Promotion Act.

Small drinking water system number

Premises name

Premises address

Phone number (999-999-9999)

E-mail address

Proposed date of opening

Date of closure

Small drinking water system owner name

Small drinking water system owner address

Small drinking water system operator name

Small drinking water system operator address

Date of water sample

Upload copy of laboratory results

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By checking this box, I acknowledge I have read, understand, and agree that the information provided in this form is correct.

Yes

I would like to receive e-mail communication from KFL&A Public Health.

Yes