Appendix A

Source Water Assessment and Protection Program Advisory Committee Questionnaire

Name: ______________________________________________________

Please mark any of the following that represent your areas of concern and/or need for additional information:

___Source water protection and relationships with other water quality programs.

___Specifically non-point source programs
___Specifically point source programs
___Both point source and non-point source programs

Please specify the information needed and/or describe specific concern(s):
____________________________________________________
____________________________________________________
____________________________________________________

___Delineation of source water protection areas.

Please specify the information needed and/or describe specific concern(s):

_____________________________________________________
_____________________________________________________
_____________________________________________________

___Identification of potential contaminant sources within source water protection areas.

Please specify the information needed and/or describe specific concern(s):

_____________________________________________________
_____________________________________________________
_____________________________________________________

___Susceptibility determinations for source water protection areas.

Please specify the information needed and/or describe specific concern(s):
_____________________________________________________
_____________________________________________________
_____________________________________________________

Source Water Assessment & Protection Program Questionnaire
Page 2

___Who benefits from implementing source water assessment and protection and how.

Please specify the information needed and/or describe specific concern(s):
______________________________________________________
______________________________________________________
______________________________________________________

Please use the remaining space on this page to express other concerns and/or information needs you may have or as additional space for describing concerns and/or information needs reflected on the previous page.

______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________

Thanks for your input. Please return this form to Maggie Davison, DEQ/WQD, 122 West 25th Street, Cheyenne, WY 82002. It would be greatly appreciated if you would return this form by November 14, 1997.

Chapters
1 | 2 | 3 | 4 | 5 | 6 | 7
Glossary | Acronyms
Appendices
A | B | C | D
Wyoming's Source Water Assessment Guidance Document Contents