Water Carrier – Application

Information requested in this form is collected under authority of the Public Health Act 1997 section 136E and 136F. This information will be used by Council to evaluate your registration as a water carrier. Please refer to the Tasmanian Drinking Water Quality Guidelines 2015 and the Guidance Note for Water Carriers to assist in the completion of this form. Should you not provide the requested information, Council will be unable to process your application.

Applicant Details

Full Name of Applicant(Required)

Business Name

Trading Name(Required)

Business Address(Required)

Street Address Address Line 2 City Post Code

Is your business address different to your postal address?

Yes

Postal Address

Street Address Address Line 2 City Post Code

Email(Required)

Phone

Mobile(Required)

Emergency Contact

First Last

Phone

Vehicle Details

Number of vehicles applying for regsitration(Required)

Make and Registration No and details for all vehicles(Required)

Make

Rego No

Outside tank material

Inside coating on tanks

Type of backflow prevention devices

Types of water hoses

Standards the equipment complies with

Press the + (plus) symbol to the right to add more vehicles.

Water Source Details

Do you extract water from a registered Private Water Supplier (i.e. TasWater)

Yes

Please list the standpipes and/or any other TasWater managed facilities you will be extracting water

From July 1st to June 30th

If NOT TasWater Where do you get your water?

Primary fill source

Who is the owner/manager of fill source

Is this fill source classified as drinking water by the manager/owner

Yes

Do you have an agreement to extract from this fill source

Yes

Please provide evidence if other than TasWater

Evidence of agreement for fill source

Max. file size: 64 MB.

If you have more than one fill source

Please list other fill sources with the owner/manager name of each additional fill source

Are these additional fill sources classified as drinking water by the manager/owner

Yes

Do you have an agreement to extract from these additional fill sources

Yes

Please provide evidence if other than TasWater

Evidence of agreement for fill source

Max. file size: 64 MB.

Please select the Council areas that you will be operating in

Sorell

Tasman

Clarence

Hobart

Glamorgan Spring Bay

Brighton

Glenorchy

Southern Midlands

Other

If other please specify

Section 136E of the Public Health Act 1997 requires only one registration from the Council where the majority of vehicles are stored for carrying out the undertaking of a commercial water carrier.

Water Carrier Activities

Please tick the relevant box(s) for the activities that you will be undertaking as a Water Carrier.

Cartage of compliant Taswater drinking water to individuals or businesses (ie from Taswater)

Cartage of non-compliant drinking water to individuals or businesses – Provide a ‘Boil water’ alert warning to recipient

Dust suppression activities (ie road works)

Cartage of water for other purposes to individuals or businesses – ‘Do not consume’ warning provided to recipient Details

Attach photos of Trucks tank and registration number(Required)

Drop files here or

Max. file size: 64 MB.

Declaration and Signature(Required)

I understand that to supply drinking water to customers as a Water Carrier, I will need to: 1. Comply with the requirements for Water Carriers as detailed in the Public Health Act 1997 2. Comply with the requirements for Water Carriers as detailed in the Tasmanian Drinking Water Quality Guidelines 2015 3. Comply with all conditions of approval against my registration, which will be subject to regular inspections by a Council Officer to determine compliance 4. Apply for renewal of registration every 12 months

Name(Required)

First Last

Date(Required)