3800-FM-WSFR0356 8/2005

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3800-FM-WSFR0356 8/2005
3930-FM-BSDW0185 10/2015
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF SAFE DRINKING WATER
Tier 1 Public Notice
CHLORINE DIOXIDE MAXIMUM RESIDUAL DISINFECTANT
LEVEL EXCEEDANCE
Exceedance of the MRDL for chlorine dioxide of 0.8 mg/L at the entrance to the distribution system, where sample(s) in
the distribution system the next day are also above the MRDL, or where the system fails to collect the required number
of distribution samples the next day is a Tier 1 violation. Tier 1 notices should convey the urgency of the situation and
make it clear to consumers what actions they must take.
Title
Public notices for Tier 1 violations and situations should have an attention-getting title. For example, “DRINKING
WATER WARNING” is better than “PUBLIC NOTICE”. You should also identify the targeted audience or the
population at risk, such as “People served by
Water System”. If
the area you serve does not follow municipal boundaries or if only a portion of the distribution system is affected,
define the area at the top of your notice.
The instructions to consumers should be next in your notice. This should be a short phrase, such as “PREGNANT
WOMEN AND YOUNG CHILDREN SHOULD NOT DRINK THE WATER”. As soon as consumers read this
phrase, they will want to know why. However, it should be kept short and concise. A short description of the
violation or situation should follow instructions to consumers. A more detailed explanation of the violation or
situation should be given in the next section of the notice.
In order to meet the multilingual requirements, you must include, at a minimum, information in Spanish regarding
the importance of the notice. The Department will notify you if, and when, you need to include information in any
other language.
Description of the Violation or Situation
Provide a detailed description of the violation or situation, including the contaminant(s) of concern, the contaminant
level(s) and when the violation or situation occurred.
Other Consumer Actions (What should I do?)
Provide a detailed description of actions consumers should take. Include the appropriate mandatory health
effects language indicated in italics on the following template. You may not change this wording. The language
on the template lists “young children” as one of the groups at increased risk. Because the potential health effects
of chlorine dioxide are based on tests on laboratory animals, there is no way to determine at exactly what age the
water is safe to drink. If your consumers have questions, encourage them to err on the side of caution. Unaffected
consumers should be told they do not need to take action but have a right to be informed of the problem.
If you are providing bottled water, your notice shall say where it can be obtained. Remember that bottled water can
also be contaminated or be high in chlorine dioxide if the bottler uses municipal water. Make sure the bottled water
meets all drinking water standards by contacting the bottler and asking for the most recent test results.
Corrective Actions (What happened? What is being done? When do you expect to return to compliance?)
In your notice, describe the corrective actions you are taking. Listed below are some steps commonly taken by
water systems with chlorine dioxide violations. Use one or more of the following actions, if appropriate, or develop
your own:



We are resetting the generator to generate the correct amount of chlorine dioxide.
We are repairing the generator.
We have already fixed the problem but it will take additional time for the extra chlorine dioxide to be flushed
from the distribution system (pipes).
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3930-FM-BSDW0185 10/2015
Contact Information
Provide your name, business address and phone number or those of a designee of the public water system as a
source for additional information concerning the notice.
Mandatory Statement to Encourage Distribution of the Notice to Others
Use the mandatory statement provided in italics on the following template to encourage notice recipients to
distribute the notice to others, where applicable. You may not change this wording.
Template Form Field Instructions
When you place your cursor in the blank form fields in the following template, look at the bottom, left corner of your
computer (just above the START button) for instructions on the information you should enter in that field. For example,
if you place your cursor over the first blank form field in the template, the instructions will read “Insert system name.”
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3930-FM-BSDW0185 10/2015
DRINKING WATER WARNING
CHLORINE DIOXIDE MAXIMUM RESIDUAL DISINFECTANT LEVEL EXCEEDANCE
PREGNANT WOMEN AND YOUNG CHILDREN SHOULD NOT
DRINK THE WATER
ESTE INFORME CONTIENE INFORMACIÓN IMPORTANTE ACERCA DE SU AGUA POTABLE. HAGA QUE
ALGUIEN LO TRADUZCA PARA USTED, O HABLE CON ALGUIEN QUE LO ENTIENDA.
has high chlorine dioxide levels.
Sample results received
showed chlorine dioxide levels of
.
This is above the standard or maximum residual disinfectant level (MRDL) of 0.8 mg/L. Chlorine dioxide is used for
disinfection, but too much of it over a short period of time may harm the development of children, infants and fetuses.
What should I do?
DO NOT USE THIS WATER IF YOU ARE PREGNANT OR GIVE IT TO YOUNG CHILDREN. Bottled water should be
used until further notice.
Some infants and young children who drink water containing chlorine dioxide in excess of the MRDL could experience
nervous system effects. Similar effects may occur in fetuses of pregnant women who drink water containing chlorine
dioxide in excess of the MRDL. Some people may experience anemia.
The chlorine dioxide violations reported today include exceedances of the EPA standard within the distribution system
which delivers water to consumers. Violations of the chlorine dioxide standard within the distribution system may harm
human health based on short-term exposure. Certain groups, including fetuses, infants and young children, may be
especially susceptible to nervous system effects from excessive chlorine dioxide exposure. There are no obvious
symptoms, but chlorine dioxide can affect development of the nervous system.

Water, juice and formula for young children and for pregnant women should not be prepared with tap
water.

Adults who are not pregnant and older children can drink the tap water because their nervous systems are
already developed. However, if you have specific health concerns, you may wish to consult your doctor.
What happened? What is being done?
Chlorine dioxide is used in small amounts every day to kill bacteria and other organisms that may be in your drinking
water. A problem occurred with our chlorine dioxide generator, and too much chlorine dioxide was released.
We will inform you when chlorine dioxide levels return to appropriate levels and when you no longer need to seek an
alternative source of drinking water.
For more information, please contact:
at
Please share this information with all the other people who drink this water, especially those who may
not have received this notice directly (for example, people in apartments, nursing homes, schools, and
businesses). You can do this by posting this notice in a public place or distributing copies by hand or
mail.
This notice is being sent to you by
PWS ID#:
.
Date distributed:

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