Environmental Management

• ​Cross Connection Control (Backflow Prevention) Forms & Documents
• Small Public Water Systems Forms & Documents
• Commercial/Industrial Stormwater Compliance Forms & Documents
• Wells Forms & Documents
  
• Well Permits and Forms

Cross Connection Control (Backflow Prevention)

• Certified Backflow Prevention Assembly Tester List​​​​​​​​​​​ ​​​ Updated 11/19/2024
  
• Cross Connection Water Supplier Contact List​​  Updated 06/26/2025
  
• 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 http://fccchr.usc.edu/list.html.

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 07/05/2022
• Groundwater Rule Amendment to SSP (Sample Siting Plan) - Updated 12/31/2009​
• Public Water System Repair Permit Form - Updated 11/16/2020​
• Request for Reclassification & Certification Form​ - Updated 07/05/2022​​
• Domestic Water Supply Permit Application​  - Updated 07/05/2022
• Emergency Notification Plan Form for Small Water Systems - Updated 07/07/2022​
• Public Notification Tier 2 Template​ - Updated 02/02/2007
  
• Historical Assessment of Radionuclide Monitoring Data Form​ - Updated 02/02/2007
  
• Small Water Systems Certified Operator List  - Updated 06/24/2025
• Water Testing Laboratories​  - Updated 07/07/2022​
  
• ​ View Funding Resources​

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 09/13/2012
• Stormwater Inspection Checklist for Non-Food Facilities ​Updated 04/26/2013

EMD Forms Main Page

Wells

• Flood Protection and Response Guidance for your Private Well. (1/28/21)​
  
• Well Ordinance (Sacramento County Code Chapter 6.28)
• Final, Adopted April 13, 2010
  
• Damaged or Missing Wells  Updated 09/24/2021
  

Well Application and Permit Forms 

• Water Supply Well/Well Repair/Pump Repair & Replacement​ ​(Updated 01/22/2025)
  
• Destruction Water Supply & Monitoring Wells​
  
• Attachment for Multiple Well Destructions​  (If there is more than 1 well to be destroyed, use this form for additional wells)
• Monitoring Wells & Soil Borings​
• Well Inactivation​​
• Cathodic Protection & Geothermal Wells
• Well -​ Property Owner's Authorization Letter Updated 06/18/2025
  
• Well Driller's Authorization Letter Updated 06/18/2025
  
• Well Driller's List  Updated 12/09/2020
  
• Compliance Bulletin: Submittal of Well Completion Reports  Updated 09/29/2021
• Compliance Bulletin: Pump Removal Repair/Replacement  Updated 10/14/2021
• Compliance Bulletin: Exploratory Borings Updated 09/29/2021
  
• ​Water Well Disinfection Stages I and II  Updated 07/12/2022
• Permanent & Temporary Conductor Casings Guidance Document​  Updated 07/12/2022
• Important Notice: Water Well Rehabilitations​  Updated 11/25/2020​

EMD Forms Main Page