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MIH 2016 CERTIFICATION FORM <br /> Name of System: Elk River PWSID: 1710004 <br /> The information in the attached Consumer Confidence Report(CCR)is accurate and has been distributed to customers <br /> served by our water supply in the following manner. You must check at least one option, however check ALL that apply: <br /> ❑ Paper copy individually mailed to all customers. <br /> ✓ Mailed notification (postcard, newsletter, etc.)that CCR is available via direct URL.You MUST provide a direct link to <br /> your system's CCR(i.e. www.minneapolismn.gov/www/groups/public/@publicworks/documents/webcontent/wcroslp- <br /> 125811.pdf)and give the option for the customer to requesta paper copy.You can also provide other links to the <br /> CCR (i.e. www.minneapolismn.gov) beyond the required direct link. <br /> Direct URL:http://www.elkriverutilities.com/pages/water-quality-report. <br /> ❑ Emailed a direct URL to CCR for bill-paying customers; emailed the CCR as a file attachment(PDF)or directly <br /> inserted CCR into the body of the email message. URL <br /> Options should include how a paper copy of the CCR can be obtained if one is not provided. <br /> Efforts must be made to reach customers who do not receive water bills, (such as apartment tenants, nursing home <br /> residents, etc.). This can be done by publicizing the availability of the CCR in the media, posting in public places, <br /> delivering multiple copies of the CCR for distribution by single-biller customers,delivering CCR to community <br /> organizations, posting on the internet, and/or including within the CCR a request for recipients to share information with <br /> non-billing customers. <br /> COMPLETE THE FOLLOW <br /> IN/G.�rG'"� <br /> Signature: �/ Print Name:Volk, Eric J. <br /> 9 <br /> Job Title:Water erintendent Phone: (763)441-2020 Date:June 1,2016 <br /> Email address:evolk@elkriverutilities.com <br /> Please print clearly <br /> PLEASE NOTE: Although MDH sent a CCR to your system, we need a"final"copy of the CCR that your system <br /> distributed for our records. Whether you reformatted the CCR,or simply added a phone number for your system on the <br /> CCR,you must return a copy of the CCR and this form to MDH. <br /> Return this form and a copy of the CCR or newspaper clipping of the CCR, by July 1,2016. <br /> Mailing Address: Fax: 651/201-4701 <br /> Minnesota Department of Health Email: health.drinkingwateradvisory@state.mn.us <br /> c/o Ms.Nancy Kadrlik <br /> Drinking Water Protection Section <br /> P. 0. Box 64975 <br /> St. Paul, Minnesota 55164-0975 <br /> RETURN A COPY OF YOUR CCR5AND THIS FORM TO MDH <br />