Kirby, TX · Bexar County
Certificate of Delivery of Tier III Public Notice to Customers
This certificate documents how a public water system delivered a Tier III notice to customers and is submitted by the system’s representative.
What this form is
A public water system uses this certificate to document how it delivered a Tier III public notice to customers, including the notice delivery methods and any notice to consecutive systems. The form identifies the water system, violation or situation, delivery dates, and certifying representative. The document says to send the completed certificate and a copy of the public notice to the TCEQ.
Who needs it
A public water system representative uses this certificate after delivering a Tier III public notice to customers.
How to submit it
Send the completed certificate and a copy of the public notice to [email protected] or mail them to TCEQ, Water Supply Division, MC-155, Attn: Public Notice, P.O. Box 13087, Austin, TX 78711-3087.
About notarization
This certificate is signed and dated without a notary; its certification is made under penalty of law, and the document identifies no notarized attachment.
How to submit this form
- 1
Download The Certificate
Download the Certificate of Delivery of Tier III Public Notice to Customers.
- 2
Complete The Certificate
Enter the public water system and violation details, notice delivery methods, dates, and certifying representative information.
- 3
Gather The Public Notice
Include a copy of the public notice delivered to customers.
- 4
Submit To The TCEQ
Send the completed certificate and notice copy to the TCEQ by the email or mailing address shown on the form.
Frequently asked questions
- What does the Tier III public notice delivery certificate document?
- It records the public water system, violation or situation, customer notice delivery methods, delivery dates, and the representative certifying the information.
- How do I submit the completed certificate?
- Send the completed certificate with a copy of the public notice to the TCEQ by email at [email protected] or by mail to the address printed on the form.
- Do I need a notary for the Tier III notice delivery certificate?
- No. The certificate is signed and dated without a notary. Its certification is made under penalty of law, and the document identifies no notarized attachment.