Outstanding System Nomination

Name of Facility*
Chapter*
- Western
- Central
- North Central
- Eastern
Contact Person
Full Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Type of Plant*
- Water
- Wasterwater
- Industrial
Age of Plant/System*
Year of Last Plant/System Upgrade*
Design Capcity/Connections*
Average Flow*
Plant/System Classification*
Description of Plant/System*
Hours of Operation*
Number of Certified Operators Employed in Active Operations*
No. of Class I Operators
No. of Class II Operators
No. of Class III Operators
No. of Class IV Operators
Is each shift operated by a properly certified operator?*
List the type and number of other Employees*
Does the plant/system offer staff the opportunity to train through KWWOA?*
Describe any involvement in KWWOA*
Nomination Submitted By
Name*
First Last
Email*
Phone*

Contact Person