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<br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />COLORADO DEPARTMENT OF HEALTH <br />Water Quality Control Division <br />4210 East 11th Avenue <br />Denver, Colorado 80220 <br /> <br />REQUEST FOR REVIEW OF DRAWINGS AND SPECIFICATIONS <br />PERTAINING TO POTABLE WATER DISTRIBUTION AND/OR STORAGE <br />SYSTEM FACILITIES. <br /> <br />(Submit in Duplicate) <br /> <br />From: <br /> <br />(Name of Municipali t-y', District, Utility, or 0ther owner) <br /> <br />Business Address: <br /> <br />Phone No. <br /> <br />To: Colorado State Deparbnent of Public Health, Water Quality Control Division <br /> <br />1. It is requested that the following drawings, specifications, reports, and de- <br />sign information be reviewed by your Department: . <br /> <br />List of Documents: <br /> <br />2 . INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: <br /> <br />A. Potable Water Storage: <br />1. Size gals. <br />2 . '0JPe Material <br /> <br />B. Water Distribution Lines: <br />1. Approximate Lengths by Slzes <br /> <br />b. <br />c. <br /> <br />ft. <br />ft. <br />ft. <br /> <br />In. <br />In. <br />In. <br /> <br />a. <br /> <br />C. This potable '.'later is treated and supplied by <br /> <br />(Municipality, District, etc.) <br /> <br />C. Estimated Project Cost <br />Estimated Bld Opening Date <br />Estimated Completion Date <br /> <br />D . Consulting Engineer: <br />Address <br />State <br /> <br />Name <br /> <br />Registered <br /> <br />Tel. No. <br /> <br />Note: DO Nor USE this form if wells and/or treatJnent works are included in these plans <br />and specifications. Use the white form for those facilities. <br /> <br />( Cont.1.'"1ued) <br /> <br />B <br />