Environmental Management

• ​Cross Connection Control (Backflow Prevention) Forms & Documents
• Small Public Water Systems Forms & Documents
  
• Commercial/Industrial Stormwater Compliance Forms & Documents
  
• Wells Forms & Documents
• Abandoned Wells Plot Plan Form

Cross Connection Control (Backflow Prevention)

• Certified Backflow Prevention Assembly Tester List   Updated 04/14/2014
  
• Cross Connection Water Supplier Contact List  Updated 03/01/2011
  
• Sacramento County Water ​Purveyors Map

Cross Connection Approved Backflow Prevention Assembly Lists

The approved list of backflow prevention assemblies is available from the University of Southern California’s Foundation for Cross-Connection Control and Hydraulic Research website located at h​ttp://fccchr.usc.edu/ ​

Please contact our office should you have any questions.

• Cross Connection Ordinance (Sacramento County Code Chapter 6.30)
  Final, Adopted April 13, 2010

EMD Forms Main Page

Small Public Water Systems

• Complete SSP (Sample Siting Plan) Updated 04/27/2009
  Adobe Acrobat   Microsoft Word
• Groundwater Rule Amendment to SSP (Sample Siting Plan) Updated 12/31/2009
• Lead Notification Form  Updated 04/27/2009
  Adobe Acrobat   Microsoft Word
• Public Water System Repair Permit Form Updated 04/27/2009
  Adobe Acrobat   Microsoft Word
• Request for Reclassification & Certification Form Updated 04/27/2009
  Adobe Acrobat   Microsoft Word
• Domestic Water Supply Permit Application Updated 10/30/2009
  Adobe Acrobat  Microsoft Word
• Emergency Notification Plan Form for Small Water Systems Updated 10/30/2009
  Adobe Acrobat   Microsoft Word
• Public Notification Tier 2 Template Updated 02/02/2007
  Adobe Acrobat   Microsoft Word
• Historical Assessment of Radionuclide Monitoring Data Form Updated 02/02/2007
  Adobe Acrobat   Microsoft Word
• Small Water Systems Certified Operator List Updated 03/20/2014
• Water Testing Laboratories Updated 03/25/2014

EMD Forms Main Page

Commercial/Industrial Stormwater Compliance

• Stormwater Inspection and Enforcement Policy  Updated 10/29/2012

• Stormwater​ Inspection Checklist for Food Facilities (Restaurants)​   Updated 03/16/2021
  

• ​​Stormwater Inspection Checklist for Non-Food Facilities Updated 03/16/2021
  

EMD Forms Main Page

Wells

• EMD Well Program Contact List  Updated 09/24/2012
• Well Ordinance (Sacramento County Code Chapter 6.28)
  Final, Adopted April 13, 2010
• Well Ordinance Enforcement Policy  Updated 09/21/2012
• Destruction of Supply Wells and Exploratory Holes (Borings) Requirements  (being revised)
• Damaged or Missing Wells  Updated 09/21/2012
• ​Well Application and Permit Form  Updated 09/21/2012
  
• Adobe Acrobat   Microsoft​ Word
• Well Site Plan Updated 09/21/2012
  Adobe Acrobat   Microsoft Word
• Well Destruction Supplement Updated 12/11/2014
• Well Driller's Authorization Letter Updated 09/21/2012
  Adobe Acrobat   Microsoft Word
• Property Owner's Authorization Letter  Updated 09/21/2012
  Adobe Acrobat   Microsoft Word
• Well Driller's List  Updated 11/07/2013
• Environmental Testing Laboratories  Updated 08/07/2012
• Water Testing Laboratories  Updated 03/25/2014
• 2013-2014 Well Fee Summary  Updated 06/28/2013
• Compliance Bulletin: Submittal of Well Completion Reports  Updated 02/26/2014
• Compliance Bulletin: Pump Removal Repair/Replacement  Updated 12/11/2013
• Compliance Bulletin: Ready Mix Sand and Cement for Water Well Seals  Updated 09/21/2012
• Compliance Bulletin: Exploratory Borings Updated 08/17/2012
• Water Well Disinfection Stages I and II  Updated 09/21/2012
• Permanent & Temporary Conductor Casings Guidance Document  Updated 09/21/2012
• Important Notice: Water Well Rehabilitations  Updated 02/21/2014
• Abandoned Wells Plot Plan Sheet  Updated 09/10/2010
  Adobe Acrobat   Microsoft Word 

EMD Forms Main Page