IL EPA-Violation Notice-Pontiac Correctional Center
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ILLINOIS ENVIRONMENTAL PROTECTION AGENCY 1021 NORTH GRANO AVENUE EAST, P.O. Box 19276, SPRINGFIELD, ILLINOIS 62794-9276 • (217) 782-3397 JB PRITZKER, GOVERNOR JOHN J. KIM, DIRECTOR 217/785-0561 February 6, 2023 CERTIFIED MAIL# 7021 2720 0000 2345 0878 RETURN RECEIPT REQUESTED Pontiac Correctional Center c/o Mindi Nurse 700 West Lincoln St. Pontiac, IL 61764 Re: Violation Notice: PONTIAC CORRECTIONAL CENTER Facility No.: IL1055500 Violation Notice No.: W-2023-00008 Dear Mindi Nurse: This constitutes a Violation Notice pursuant to Section 31 (a)(]) of the lllinois Environmental Protection Act ("Act"), 415 ILCS 5/31 (a)( 1), and is based upon a review of available information and an investigation by representatives of the Illinois Environmental Protection Agency ("Illinois EPA"). The Illinois EPA hereby provides notice of alleged violations of environmental laws, regulations, or permits as set forth in Attachment A to this notice. Attachment A includes an explanation of the activities that the Illinois EPA believes may resolve the specified alleged violations, including an estimate of a reasonable time period to complete the necessary activities. Due to the nature and seriousness of the alleged violations, please be advised that resolution of the violations may also require the involvement of a prosecutorial authority for purposes that may include, among others, the imposition of statutory penalties. A written response, which may include a request for a meeting with representatives of the Illinois EPA, must be submitted via certified mail to the Illinois EPA within 45 days of receipt of this letter. If a meeting is requested, it shall be held within 60 days of receipt of this notice. The response must include information in rebuttal, explanation, or justification of each alleged violation and a statement indicating whether or not the facility wishes to enter into a Compliance Commitment Agreement (4'CCA") pursuant to Section 31(a) of the Act. If the facility wishes to enter into a CCA, the written response must also include proposed terms for the CCA that includes dates for achieving each commitment and may include a statement that compliance has been achieved for some or all of the alleged violations. The proposed terms of the CCA should contain sufficient detail and must include steps to be taken to achieve compliance and the necessary dates by which compliance will be achieved. 2125 S. First Street, Champaign, IL 61820 (217) 278-5800 1101 Eastport Plaza Dr., Suite 100, Colhnsv1lle, ll 62234 (618) 346-5120 9S11 Harrison Street, Des Plaines, IL 60016 (847) 294 4000 S95 S. State Street, Elgin, IL 60123 (847) 608-3131 2309 W Main Street, Suite 116, Marion, IL 62959 (618) 993-7200 412 SW Washington Street, Suite D, Peoria, IL 61602 (309) 671-3022 4302 N. Main Street, Rockford, IL 61103 (815) 987-7760 PLEASE PRINT ON RECYCLED PAPER Page 2 of2 IL 1055500 PONTIAC CORRECTIONAL CENTER VN W-2023-00008 The Illinois EPA will review the proposed terms for a CCA provided by the facility and, within 30 days of receipt, will respond with either a proposed CCA or a notice that no CCA will be issued by the Illinois EPA. If the Illinois EPA sends a proposed CCA, the facility must respond in writing by either agreeing to and signing the proposed CCA or by notifying the Illinois EPA that the facility rejects the terms of the proposed CCA. If a timely written response to this Violation Notice is not provided, it shall be considered a waiver of the opportunity to respond and meet, and the Illinois EPA may proceed with referral to a prosecutorial authority. Written communications should be directed to: Illinois EPA Division of Public Water Supplies Attn: Adam J. Nutt, CAS #19 P.0. BOX 19276 Springfield, IL 62794-9276 All communications must include reference to this Violation Notice number, W-2023-00008. Questions regarding this Violation Notice should be directed to Adam J. Nutt at 217/785-0561. Sincerely, vbg.~~ Manager, Compliance Assurance Section Division of Public Water Supplies Bureau of Water Attachments cc: Richard B. Gramley Jared Brunk Rodney Thacker BOW ID: Wl050600002 PAGE NO. 1 OF 6 ATTACHMENT A PONTIAC CORRECTIONAL CENTER, IL1055500 VIOLATION NOTICE NO. W-2023-00008: Questions regarding the violations identified in this attachment should be referred to Adam J. Nutt at (217) 785-0561. A review of information available to the Illinois EPA indicates the following violations of statutes, regulations, or permits. Included with each type of violation is an explanation of the activities that the Illinois EPA believes may resolve the violation including an estimated time period for resolution. Water Trea tment Plant/Distribution Sy stem Maintenance There are structure/maintenance problems that threaten the quality of the drinking water provided to customers. Violation Date 08/09/2022 Violation Description Failure to Remove all chemical storage for the retired sodium silicate / sodium hypochlorite system and ensure that the remaining injection port is adequately sealed to ensure the sanitary integrity of the finished water line. Rule/Reg. Section 18 of the Act, 415 ILCS 5/18, 601.lOl(a) and 604.135(a). Violation Date 8/09/2022 Violation Description Failure to develop and maintain a systematic flushing program. {on-going violation) Rule/Reg. Section 18 of the Act, 415 ILCS 5/18, 601.101 (a) and 604 .1425 (c). Violation Date 08/09/2022 Violation Description Inadequate booster pump capacity. Each booster pumping station must contain no fewer than two pumps with capacities such that maximum demand can be satisfied with the largest pump out of service. Section 18 of the Act, 415 ILCS 5/18, and 35 Ill. Adm. Code 601.lOl(a) and 604.1215(a). Rule/Reg. and 35 Ill. and 35 Ill. Adm. Adm. Code Code PAGE NO. 2 OF 6 ATTACHMENT A PONTIAC CORRECTIONAL CENTER, IL1055500 VIOLATION NOTICE NO. W-2023-00008: Drinking Water Monthly Operating Reports All public water supplies are required to submit reports summarizing daily operational activities to the Regional Illinois EPA office each month. Compliance with this is expected within 30 days by submission of the required reports. Violation Date 08/09/2022 Violation Description Failure t o submit Monthly Operating Reports within 30 days of the last day of each month. These reports must be prepared on an operating report form approved by the Agency, must be signed by the Responsible Operator in Charge, and submitted within 30 days of the end of the month. A copy of the operating report records must be maintained by the official custodian of the public water supply. Rule/Reg. Section 18(a) and 19 of the Act, 415 ILCS 5/18 and 5/19, and 35 Ill. Adm. Code 601.101 (a) and 604 .165 (a), (c), and (d) . Nitrification Action Plan Any community water supply distributing water without a free chlorine residual must create a Nitrification Action Plan (NAP). The NAP must: a. Contain a plan for monitoring total ammonia as nitrogen (N) , free ammonia as N, nitrite as N, nitrate as N, monochloramine residual, dichloramine residual, and total chlorine residual. b. Contain system specific levels of the chemicals in listed in A when action must be taken. c. Contain specific correction actions to be taken if the levels listed i n Bare exceeded. d. Be maintained on site and made available to the Agency upon request. Violation Date 08/09/2022 Violation Description No Nitrification Action Plan has been created for the distribution system. A NAP for the distribution system must be created. Rule/Reg. Sec tion 18 of the Act, 60 1 .l0l(a) and 604.140. 415 ILCS 5/18, and 35 Ill. Adm. Code PAGE NO. 3 OF 6 ATTACHMENT A PONTIAC CORRECTIONAL CENTER, IL1055500 VIOLATION NOTICE NO. W-2023-00008: Drinking Water Cross-Connection Control Program All public water supplies must have an active cross-connection control program. It is not possible for the Agency to evaluate whether a water system's cross-connection control program is comprehensive without the ability to evaluate an ordinance or- service agreement. Compliance is expected to be achieved by submitting your water supply's cross-connection control ordinance or water use agreement within 90 days to the Illinois EPA. Additionally, provide an implementation schedule including when your water system will conduct its cross-connection survey of the distribution system; how your water system will evaluate high risk service connections; and how your water system will track cross connection control devices and their annual inspection. Violation Date 08/09/2022 Rule/Reg. Violation Description Failure to have a comprehensive cross-connection control program. (on-going violation) Section 18 of the Act,· 415 ILCS 5/18, and 35 Ill. Adm. Code 601.101 (a) and 604 .1505 (a) and (b). Drinking Water Cross-Connection Program Device Inventory A community water supply must maintain records of all backflow preventers that require annual testing. To achieve compliance, an inventory of all backflow prevention devices in the system must be created, and documentation submitted to the Illinois EPA within 90 days. Violation Date 08/09/2022 Violation Description Failure to maintain records of all backflow preventers require annual testing. Rule/Reg. Section 18 of the Act, 415 ILCS 5/18, 601.101 (a) and 604 .1505 (b) (5). that and 35 Ill. Adm. Code Drinking Water Cross-Connection Device Testing A community water supply must assure all backflow preventers are tested at least annually. To achieve compliance, each backflow prevention device must be tested, and documentation submitted to the Illinois EPA within 90 days. Violation Date 08/09/2022 Violation Description Failure to perform annual testing of all backflow prevention devices in the system. (on-going violation) Rule/Reg. Section 18 of the Act, 415 ILCS 5/ 18 , 601.101 (a) and 604 .1510 (a). and 35 Ill. Adm. Code PAGE NO. 4 OF 6 ATTACHMENT A PONTIAC CORRECTIONAL CENTER, IL1055500 VIOLATION NOTICE NO. W-2023-00008: Emergency Operation Plan Each community water supply must develop an EOP for the provision of water during emergency circumstances including earthquakes, floods, tornados, and other disasters. The EOP must include a review of methods and means by which alternative supplies of drinking water could be provided in the event of destruction, impairment, or contamination of the community water supply. The community water supply must review its emergency operations plan at least every three years and revise the plan as necessary. The plan must be maintained on site and made available to the Agency, upon request . Violation Date 08/09/2022 Violation Description At the time of inspection, there was no Emergency Operations Plan (EOP) available for review. Rule/Reg. Section 18 of the Act, 604 .135 (d) . 415 ILCS 5/18, and 35 Ill. Adm. Code Drinking water Monitoring Site Plan Requirements All public water supplies (PWSs) must achieve and maintain compliance with the monitoring and reporting requirements of the Environmental Protection Act. Your supply did not submit required written sample site plans. This written plan must be representative of the water throughout the distribution system and be approved by special exception permit. Compliance with this is expected to be achieved within 30 days by submitting the required written sample site plans to the Illinois EPA. Violation Date 8/09/2022 Rule/Reg . 8/09/2022 Rule/Reg. 8/09/2022 Rule/Reg. Violation Description Failure to submit, for Agency approval, a written sample siting plan for coliform that identifies sampling sites representative of water throughout the distribution system . (on-going violation) Section 18 of the Act, 415 ILCS 5/18, and 35 Ill. Adm . Code 611.1053 (a) (1) . Failure to submit, for Agency approval, a written sample siting plan for lead and copper that identifies sampling sites representative of water throughout the distribution system. (ongoing violation) Section 18 of the Act, 415 ILCS 5/18, and 35 Ill. Adm. Code 611. 356 (a). Failure to submit, for Agency approval, a written sample siting plan for disinfection by-product samples. (on-going violation) Section 18 of the Act, 415 ILCS 5/18, and 35 Ill. Adm. Code 611.972(a). PAGE NO. 5 OF 6 ATTACHMENT A PONTIAC CORRECTIONAL CENTER, IL1055500 VIOLATION NOTICE NO. W-2023-00008: Drinking Water Monitoring All Public Water Supplies (PWSs) must achieve and maintain compliance with the monitoring and reporting requirements of the Environmental Protection Act. Your supply did not submit required sample results from a certified laboratory. Sample results are due to the Illino is EPA by the 10 th of the month following the monitoring period. Compliance with these monitoring and reporting requirements is expected to be achieved within the next monitoring period by submitting sample results for each monitoring program in accordance with your supply's sample site plans. Violation Date 8/09/2022 Rule/Reg. Violation Descripti on Fai lure to col lect samples and submit coliform sample results . Se ctions 18 a nd 19 of the Act, 4 15 ILCS 5/18 and 5/19 , and 35 Ill. Adm . Code 611.1053 (a) (2) and (3) . 8/09/2022 Fa ilure to collect samples and . s ubmit disinfectant residual sample res ults. Sec tions 1 8 and 19 of the Act, 415 ILCS 5/18 and 5/19 , and 35 Ill . Adm . Code 611.382( a ) and (c). Rule/Reg. 8/09/2022 Rule/Reg. 8/09/2022 Rule/Reg. Failure t o collect samp les and s ubmit lead and copper sample results. Sections 18 and 19 of the Act, 41 5 I LCS 5/18 and 5/19 , and 35 Ill. Adm. Code 611. 350(h) and 611. 356(c) . Failure to collect s amples and subm i t disinfectants and disinfection by-products (DBPs) sample results . Sections 18 and 19 o f the Ac t, 41 5 ILCS 5/18 and 5/19 , and 35 Ill. Adm. Code 611. 97 1 (a) . Notification of Ownership or Responsible Operational Personnel Every community public water supply (PWS) is requ ired to submit a statement of ownership to the Illinois EPA identifying a n Owner , Official Custodian , Administrative Contact, Responsible Operator in Charge (ROINC) , and Sample Bottle Collector. Compliance with this is expected within 30 days by determining the ownership or responsible personnel and submitting the appropriate form. Violation Date 08/09/2022 Ru l e /Reg Violation Description Lack of "Notification of Responsible Operational Personneln form on . file with the Illinois EPA identifying a Responsible Operator in Charge (ROINC). Section 18(a) of the Act, 415 ILCS 5/18, and 35 Ill. Adm. Code 603.103(e). PAGE NO. 6 OF 6 ATTACHMENT A PONTIAC CORRECTIONAL CENTER, ILl0SSSO0 VIOLATION NOTICE NO. W-2023-00008 : Responsible/Certified Operator Every community public water supply (PWS) is r e quired to employ on its operational staff at least one person certified as competent as a water supply operator. Compliance with this is expe cted within 15 days by obtaining a certified operator and submitting the "Notifi cation of Ownership and Responsible Operational Personnel" form. Violation Date 08/09/2022 Violation Description Op erations of a Class B Water system without a properly ce rtified drinking water operator. ' An operator with a valid Class B Certification or higher is requ~red. Rule/Reg Section 18(a) of the Act, 415 ILCS 5/18, and 35 Ill. Adm. Code 601.l0l(a), 603.l0l(d), 603.103(a) and (b), and 681.215(a) and (b) • tlHnui\ ~nvir91\n1e nt9 1- 1>1·ot<"cti<>~l Agency Notification of Responsible Operational Personnel Please use this form to make community water supply tCWS) contact changes. CWS Name: Number: .:.:IL=------ REASON FOR CHANGE (check all aoolicable boxes) Change in Owner and/or Official Custodian Information Change in Responsible Operator in Charge Information Change in Administrative Contact Information Updating phone, mailing address, and/ or E-Mail information onlv Change of Sample Collector Information This is a NEW CWS OWNER (OW) If the CWS is privately owned, identify the individual (and contact information) exercising direct supervision over the CWS in accordance with 35 Ill. Adm. Code 603.101 (e.g., Mobile Home Park, Apartment Complex, or Private Business. etc.). This individual must sign. If the CWS is publically owned or owned by private corporation, or regularly organized body, identify the entity exercising direct supervision over the CWS in accordance with 35 Ill. Adm. Code 603.101 (e.g., Municipality, Water District, Water Corporation, Water Cooperative, Conservancy District. Subdivision, or Association). If an entity, only complete Entity Name, Business#, and Address (no signature required) and then complete OFFICIAL CUSTODIAN (OC) box. Name (Individual) 2! Entity Name (Municipality, Water District, Assoc., etc.) Title: Cell#: Home#: E-Mail: Business Address (if applicable) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ( ) Business#: (_ _),_ _ _ _ _ __ ( ) Fax#: ( )_ _ _ _ _ __ __ _______ __ _____ If Individual, Signature:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Date:_ _ _ _ _ _ _ _ _ _ __ ( Sicmature of lndividua/J OFFICIAL CUSTODIAN (OC) If the owner is an Entity as listed above (Municipality, Water District. Water Corporation. Water Cooperative, Conservancy District, Subdivision or Association, etc.) identify a person who acts on behalf and is responsible for the supply. This person should be an elected official of a municipality, member of the board, or an officer of the organization that runs the supply (mayor, president, chairman. etc. l. Name: Title Cell# Home# E-Mail: (print) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (if applicable) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ( _ _)_ _ _ _ __ (_ _)_ _ _ _ __ Business Address Business#: (_ _)_ _ _ _ __ Fax#: ( ) Signature:, _______________________ Date:. ____________ (Sionature of Official Custodian) ADMINISTRATIVE CONTACT (AC) An owner or official custodian may designate an administrative contact lo oversee daily managerial operations of the CWS. Any notice provided by the Agency to the AC shall be considered notice to the owner or official custodian . These notices may include, but are not limited to Sample Demand Letters, Public Notice Advisories, Violation Notice, Notice of Intent to Pursue Leaal Action, and notices of reoulatorv reouirements and oermiltino transactions. Name: (print)._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Title: Cell#: (_ _),_ _ _ __ Work#:(, _ __,)_____ __ Fax#: (_ __,l,_ _ _ _ __ Home#: (_ _)._ _ _ _ __ E-Mail: Signature:_______________________ Business Address Date:____________ (Signature of AC) Signature of the Owner or Official Custodian is required before Illinois EPA will add or change an AC contact: I hereby duly authorize_ _ _ _ __ _ _ _ _ _...,....-_ _ _ _ _ _ _ _ _ (print) as my Agent, with actual authority to conduct legal transactions arising from the daily managerial operations of the CWS on my behalf. Signature:_______________________ (Signature of Owner or Official Custodian) IL 532-0987/0164 (revised 01-14) Date:_ _ __ __ _ _ _ _ __ tttlnol~ En,viro~\1l1COW.t rtotcrticn1 f\gr-ncy RESPONSIBLE OPERATOR IN CHARGE {ROINC} Identify the certified operator(s) designated pursuant to 35111. Adm., Code 603.103 in responsible charge of the CWS operations. The ROINC runs and oversees daily water treatment and distribution operations. A CWS must select only one designated ROINC for treatment and one designated ROINC for distribution. The treatment ROINC and distribution ROINC mav be the same nerson. ' Current ROINC on FIie: Please check box that best describes status of current RO/NC on File I Current ROINC on file will no lonMr be emoloved or under contract with PWS effective I Current ROINC on file is still workina with PW$ but will no lonner servinQ as ROINC. NEW ROINC 1 Please Check One: Name: (print) Circle Certificate Class: A B C Circle One: Treatment & Distribution Cell#: ( _ ) Home#: E-Mail: Signature: Full Time Emp loyee or (print name)' I Contract Operator (Include coov of contractJ Business Address D Treatment Only Work#: ( (_) Fax#: ( Distribution Only ) ) Date: ( Sionature of RO/NC 1J NEWROINC2 Please Check One: Name: (print) Circle Certificate Class: A B C Cell#: ( _ ) Home#: ( _ ) Full Time Employee or D Circle One: Work#: ( ) Fax#; ( ) Contract Operator {Include CORY of contract> Buslness Address Distribution Only E-Mail: Signature: Date: (Signature of RO/NC 2) Signature of Owner1 Official Custodian 1 or Administrative Contact is reguired before Illinois EPA will add or change a ROINC contact,s). As Owner/Official Custodian or Administrative Contact, I (print name), accept and assign the duties and responsibilities for the proper operation and maintenance of the public water supply facilities by the operator(s) listed above as being in responsible charge. Signature: Date: (Sionature of Owner/Official Custodian or Administrative ContactJ Sample Collector/Bottle Recipient Identify the person employed by the cws that will collect samples and complete the paperwork associated with sampling. Bottle Mailing Address Name: Cell#: Home#: E-Mail: _ _ _ _ __ _ __ _ _ _ _ _ _ __ _ _ _ (print) No P .O .Box Numbers Allowed ( _ _ )_ _ _ _ _ _ Work#: ( _ __ ) _ _ _ _ __ ( _ _) Fax#: ( ) _ _ _ _ __ Signature:....,,,..--.,,...-,-----,---------------(Samp/e Collector's Signature) Date: _ _ _ _ _ _ _ _~ -- Completion of this form shall indicate acceptance of the duties and responsibilllies for the proper operation and maintenance of the public water supply facilities by both the owner or official custodian and the certified operators designated as being in responsible charge pursuant to 35 \II. Adm. Code 603.101 (d). Please be advised that ii is the responsibility of the owner, official custodian and the certified operator(s) in responsible charge to notify this office within 15 days of any changes in responsible personnel. Completion and submittal of this form will satisfy the notification of responsible personnel requirements of Title 35: Environmental Protection. Subtitle F: Pub'ic Water Supplies, Chapter I: Pollution Control Board. Part 603, Sections 603.101, 603.102, and 603.103. Be sure lo retain copies of this document for your files. Should you need additional forms, please call (217)785-0561 or download al http://www.eoa.stateJ LuslwaterLopera~or•cert/dfinking•water/forms/notificalion-of-ownership.pdf. Return this completed form to: Illinois Environmental Protection Agency, Bureau of Waler #19, 1021 North Grand Ave East, P .0. Box 19276, Springfield, IL 62794-9276 This Agency is authorized to require this information under 415 ILCS 5/4(b)(2012), Disclosure of this information is required. Failure to do so may result in a civil penalty up to $1,000.00. Any person who knowingly makes a false, fictitious. or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony. (415 ILCS 5144(h)) IL 532,0987/0164 (revised 01-14) 11'l, •t· r n -;y < ► n nH 1-n t;lf flrrtt< cli<)n 1 ~e nc , RESPONSIBLE OPERATOR IN CHARGE {ROINC} Identify lhe certified operator(s) designated pursuant to 35111. Adm. Code 603.103 in responsible charge of the CWS operations. The ROINC runs and oversees dally water treatment and distribution operations. A CWS must select only one designated ROINC for treatment and one designated ROINC for distribution. The treatment ROINC and distribution ROINC mav be the same oerson. Current ROlNC on File: Please cheek box that best describes status of current RO/NC on File I Curren! ROINC on file will no lancer be emoloved or under contract with PWS effective I Current ROINC on file is still workino with PWS but will no lancer Servino as ROINC. NEWROINC 1 Please Check One: Name: (print} Circle Certificate Class: A B C Circle One Treatment & Distribution } Cell#: ( ) Home#: ( E-Ma il: Signature: __ __ Full Time Emolovee or (print name) Contract Ooerator (Include coav of contract, Business Address D Treatment Only Work#: ( Fax#: ( D1str1bution Only _ ) } Date: ( Sionature of RO/NC 1J NEW ROINC 2 Please Check One: Name: (print) Circle Certificate Class: A B C ) Cell#: ( Home#: ( _ ) E-Mail: Signatu.re: __ Full Time Employee or D Circle One: Work#: ( ) Fax#: ( ) Contract o~rator {include conv of contractJ Business Address Distribution Only Date: (Signature of RO/NC 2) Signature of Owner1 Official Custodlan 1 or Administrative Contact is reguired lbefore Illinois EPA will add or change a ROINC contact(s}. As Owner/Official Custodian or Administrative Contact, I (print name}. accept and assign the duties and responsibilities for the proper operation and maintenance of the public water supply facilities by the operator(s) listed above as being in responsible charge. Sjgo.atu.re: --- Date: fSiQnature of Owner/Official Custodian or Administrative ContactJ Sample Collector/Bottle Recipient Identify the person employed by the cws that will collect samples and complete the paperwork associated with sampling. Name: Cell#: Home#: E-Mail: _ _ _ _ _ _ _ __ _ __ _ _ _ _ _ _ _ _ _ (print) (_ _)_ _ __ _ _ Work#: ( _ _ _ )_ _ _ _ __ ( _ _) Fax#: ( )_ _ _ _ __ Signature:________________________ Bottle Mailing Address No P.0.Box Numbers Allowed Date:_ _ _ _ _ _ _ _ _ __ (Sample Co//ector·s Signature) Complelion of this form shall indicate acceptance or the duties and respons bilities for the proper operation and maintenance of the public water supply facilities by both the owner or official custodian and the certilied operators designated as being in responsible charge pursuant to 35 Ill. Adm. Code 603.101(d). Please be advised that it is the responsibility of the owner. official custodran and the certified operator(s) in responsible charge to notify th,s office with"n 15 days of any changes in responsible personnel. Complefon and submittal of this form will satisfy the notilication of responsible personnel requirements of Title 35: Environmental Protection. Subtitle F: Public Water Supplies. Chapter I: Pollution Control Board, Part 603, Seel ans 603.101, 603.102, and 603.103. Be sure to retain copies of this document for your files. Should you need additional farms please call (217)785-0561 or download at hUp:llwww.epa.state il,~lerloperalor-t e,Wrinking-wateyffarmslnQ!!li&;alion-of-ownership p(lf. Return this completed form to: Illinois Environmental Protection Agency, Bureau of Water #19, 1021 North Grand Ave East, P.0. Box 19276, Springfield, IL 62794-9276 This Agency is author"zed to require this information under 415 ILCS 5{4(b)(2012). Disclosure of this information is required. Failure to do so may result in a civil penalty up lo $1,000.00. Any person who knowingly makes a false fictitious. or fraudulent material statement. orally or 1n writing. to the lninois EPA commits a Class 4 fe·ony. A second or subsequent offense after conviction is a Class 3 felony. (415 ILCS 5/44(hJ) IL 532.0V87/0164 (revised 01-141 I