Q-2, r. 40 - Regulation respecting the quality of drinking water

Schedule Disposition versions

2012-09-01

SCHEDULE 3

(s. 10.1)

INFORMATION PROVIDED IN THE DECLARATION BY THE PERSON IN CHARGE OF A DISTRIBUTION SYSTEM

— Identification of distribution system:

— Type of establishment or institution according to user base:

— Name of owner of distribution system:

— Address:

— Telephone:

— Name of operator if different from owner:

— Address:

— Telephone:

— Operation start date and end date:

— Chlorinated water: yes / no

— Ozonated water: yes / no

— Chloraminated water: yes / no

— Water treated with chlorine dioxide: yes/no

— Water disinfected with a virus elimination effectiveness equal to or greater than 99.99%: yes/no

— Oxidized water: yes/no; if yes, type of oxidizer used

— Record kept pursuant to section 22 or 22.1: yes/no

— Surface water in whole or in part: yes / no

— Supplied by another distribution system subject to testing requirements: yes / no

— Total number of persons supplied:

— Signature of person in charge of the distribution system

— Date of the declaration

O.C. 467-2005, s. 51; O.C. 70-2012, s. 73.