Fillable Bohemercont (Commonwealth of Massachusetts)

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Bohemercont (Commonwealth of Massachusetts)

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U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Massachusetts Department of Environmental Protection - Drinking Water Program
Official Email Address and Emergency Contact List
(For Boards of Health)
I. Instructions
Please submit your BOH Official Email Address & Emergency Contact List to MassDEP at the address below. Your
official email address should be the address where you wish to receive official MassDEP/DWP information e.g., copies of
sanitary surveys, etc. Emergency contacts should be prioritized in the order that you want to be notified by MassDEP
staff in case of an emergency. Contact #1 should contain the name and contact information of the BOH person that you
want to have contacted first in an emergency; if Contact #1 cannot be reached then we will attempt to contact the
person identified as Contact #2; and so on.
Please submit your Official Email Address & Emergency Contact List or any subsequent changes to MassDEP Drinking Water
Program; 1 Winter Street - 5
th
floor; Boston, MA 02108; Attn: BOH Emergency Contact. You may also respond by email to
Program.Director-DWP@mass.gov, Subject: BOH Official Email Address and Emergency Contact.
II. Board Information
City/Town:
Board Name:
Address 1:
Address 2:
City/Town:
State and Zip:
II. Official BOH Email Address for Copies of Drinking Water Program Correspondence
Email Address:
Email Address:
III. BOH Emergency Contacts
Name:
Title:
Work Phone:
Evening or Cell
Phone:
Work Email:
Evening Email:
2.
Name:
Title:
Work Phone:
Evening or Cell
Phone:
Work Email:
Evening Email:
3.
Name:
Title:
Work Phone:
Evening or Cell
Phone:
Work Email:
Evening Email:
4.
Name:
Title:
Work Phone:
Evening or Cell
Phone:
Work Email:
Evening Email:
Rev 6-6-2019
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Bohemercont (Commonwealth of Massachusetts)

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Completed 18 July 2020

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