1. W HAT THEY NEED TO KNOW, WHEN THEY NEED TO KNOW IT - F ORMULATING EFFECTIVE AND ACCURATE PUBLIC NOTIFICATION MESSAGES Fran Watkins Marshall, J.D., M.S.P.H. South Carolina Department of Health and Environmental Control 23 March 2016

2. My Perspective: ■ MSPH – Focus: Environmental Health/ Industrial Hygiene (1990) ■ Certified Industrial Hygienist, worked in petro/chemical industry 13 years (1990 – 2003)  Certified Hazardous Materials Specialist  Certified Interior Structural Firefighter  Certified (NC) Medical Responder  Trained in Wildlands Fire Fighting ■ Juris Doctor / Trial Attorney (2003 – 2008) ■ State Toxicologist & SC EPHT Program Manager (October 2008 – 2013) ■ Environmental Risk Consultant (2013 – present) – Including hourly consultations with SC DHEC 2

3. Disclaimer ■ The opinions expressed in this presentation are my own and do not represent those of any current or previous employers or co- workers. 3

4. Outline of Presentation ■ Background on EPA Safe Drinking Water Public Notice Regulation – Purpose of Notices – 10 Required Elements of a PN – Tiers of PNs ■ Specific Notices – Disinfection By-products (DBP) – Lead – Unregulated Contaminants Monitoring Rule ■ Communicating Risks: Some Practical Guidance

5. SDWA PUBLIC NOTICE (PN) RULE

6. Revision of PN Rule in 2000 The Public Notice (PN) Rule is a part of the Safe Drinking Water Act. In 2000, the EPA revised the PN Rule to require faster notice in emergencies and fewer notices overall. The purpose of PN is to ensure that drinking water customers know if there is a problem with their drinking water.

7. More Specifically, Notices Alert Customers…. …If there is a risk to public health from consumption of the water …If the water doesn’t meet drinking water standards, …If the system has been granted a variance or …If a system has been given more time to comply with a new regulation.

8. 10 Required Elements in a PN 1.A description of the violation that occurred, including the contaminant(s) of concern, and the contaminant level(s); 2.When the violation or situation occurred; 3.The potential health effects (including standard required language); 4.The population at risk, including sub-populations vulnerable if exposed to the contaminant in their drinking water; 5.Whether alternate water supplies need to be used;

9. 10 Required Elements in a PN 6.What the water system is doing to correct the problem; 7.Actions that consumers can take; 8.When the system expects a resolution to the problem; 9.How to contact the water system for more information; and 10. Language encouraging broader distribution of the notice.

12. Tiers of PN: Tier 1 Immediate Notice (within 24 hours) ■ Required: Any time a situation occurs where there is the potential for human health to be immediately impacted, water suppliers have 24 hours to notify people who may drink the water about the situation. ■ Delivery Method: Water suppliers must use media outlets such as television, radio, and newspapers, post their notice in public places, personally deliver a notice to their customers, or an alternative method approved by the primacy agency.

13. Tier 1 Examples: ■ Total coliform MCL violations where fecal coliform or E. coli are present; ■ Nitrate, nitrite or total nitrate and nitrite MCL violation; ■ Occurrence of a waterborne disease outbreak or other waterborne emergency.

14. Tiers of PN: Tier 2 Notice As Soon As Possible (within 30 days) ■ Required: Any time a water system provides water with levels of a contaminant that exceed EPA or state standards or that hasn't been treated properly, but that doesn't pose an immediate risk to human health, the water system must notify its customers as soon as possible, but within 30 days of the violation. ■ Delivery Method: Notice may be provided via the media, posting, or through the mail.

15. Tier 2 Example: ■Maximum contaminant level (MCL), maximum residual disinfectant level (MRDL), and treatment technique requirement violations, except where Tier 1 notification is required by regulation or by the primacy agency.

16. Tiers of PN: Tier 3 Annual Notice ■ Required: When water systems violate a drinking water standard that does not have a direct impact on human health (for example, failing to take a required sample on time) the water supplier has up to a year to provide a notice of this situation to its customers. ■ Delivery Method: Tier 3 PN must be delivered the same way as Tier 2 PN. The extra time gives water suppliers the opportunity to consolidate these notices and send them with Annual Water Quality Reports (Consumer Confidence Reports).

17. Tier 3 Examples: ■ Monitoring violations ■ Testing procedure violations ■ Operation under a variance or exemption ■ Special notice for fluoride secondary maximum contaminant level (SMCL) exceedances

19. SPECIFIC PN TEMPLATES DBP/Lead

20. Toxicity Toxicity is an inherent property of a chemical, or element (in the case of lead). What changes is the potential to be exposed to it and to how much one is exposed. Old adage, “the dose (how much) makes the poison.” 20

21. DBP Disinfection By-Products are chemicals formed when residual chlorine/chloramine combines with organic matter in water. EPA Limits: Maximum Residual Disinfectant Limits (4 mg/L as CL 2 ) And DBP Maximum Contaminant Levels (MCLS) TTHMs 0.08 mg/L HAA5 0.06 mg/L Bromate 0.01 mg/L Chlorite 1.0 mg/L

24. Lead PNs Lead is a metal that historically may have been a component of water system piping OR in solder of copper pipes in homes build prior to 1987. EPA Limits: Action Level of 15 parts per billion (ppb). MCLG of zero.

25. 25 Information Requirements for Non- Transient, Non- Community Systems

26. 26 Information Requirements for Non- Transient, Non- Community Systems

27. 27 Information Requirements for Community Water Systems

28. EPA’s Language What Does It Say? ■ “The treatment technique for the rule requires systems to monitor drinking water at customer taps. If lead concentrations exceed an action level of 15 ppb or copper concentrations exceed an action level of 1.3 ppm in more than 10% of customer taps sampled, the system must undertake a number of additional actions to control corrosion.” What Does It Mean? ■ Unlike most regulated contaminants, EPA does not have a Maximum Contaminant Level (MCL) for lead. ■ Instead, the Lead and Copper Rule is a technology based standard. An Action Level is set to trigger specific actions to be taken before lead in the water becomes a health risk. 28

29. EPA’s Explanation of an Action Level ■ “The MCLG for lead is zero and the action level is 15 ppb. The MCLG is the level of a contaminant in drinking water below which there is no known or expected risk to health. The MCLGs allow for a margin of safety. The action level is the concentration of a contaminant which, if exceeded, triggers treatment or other requirements which a water system must follow.” 29

30. EPA vs. CDC Messaging… ■ While the EPA does not consider the Action Level for lead to be a health standard (above which there is risk of adverse health effects and below which is safe), there is conflicting information about the EPA’s Action Level on/in the Centers for Disease Control and Prevention (CDC’s) web site and publications. ■ Note that the EPA does establish an MCL Goal (MCLG) of zero based on its toxicity. 30

31. Common Sources of Lead ■ Lead paint ■ Lead in batteries ■ Ceramic glazes (manufactured in other countries) ■ Hobbies (fishing weights, stained glass ■ Some candy from other countries ■ In soil near roadways (from when leaded gasoline was used) ■ Occupational exposures (that can be brought into cars or homes to expose family members as well) ■ Drinking water 31

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33. Unregulated Contaminants Monitoring Rule EPA collects data for chemicals and microbes that may be present in drinking water, but are not currently subject to EPA drinking water regulations.

34. Unregulated Contaminants Monitoring Rule (UCMR) ■ PWSs that are subject to UCMR are also subject to the Consumer Confidence Report (CCR) and the Public Notification (PN) rules. ■ The CCR rule requires that community water systems (CWSs) report monitoring results when unregulated contaminants are detected (40 CFR 141.151). ■ The PN rule requires that water systems notify the public that the results are available (40 CFR 141.207).

35. Q&A on Reporting for Small Systems What do water systems serving 10,000 or fewer people ("small systems") need to do? ■ As proposed, small water systems selected for monitoring will need to collect samples for EPA, using sampling kits and following sampling instructions provided by the Agency's support contractor. ■ EPA will arrange for sample analysis and will review monitoring results for small Public Water Systems. After review, EPA will: – Issue reports to the Public Water Systems – Send copies of the reports to their respective states – PWSs should save the report as their official record.

36. COMMUNICATING RISKS Some Practical Guideance

37. Uncertainty, Shades of Grey… 37

38. So What Do We Do? ■ Focus on what we do know. ■ Provide actionable information that can reduce potential exposure. ■ Remember that communication involves listening, too. ■ Take advantage of available materials. ■ Communicate early and often. ■ Document required communication. 38

39. What We Know…DBP ■ The risk of exposure to DBP is extremely small compared to the risk of water that is not disinfected. ■ The primary reason for disinfecting water is to prevent exposure to diseases associated with water-borne bacteria: – Water can come from a variety of sources, such as lakes and wells, which can be contaminated with germs that can make people sick. Germs can also contaminate water as it travels through miles of piping to get to a community. To prevent contamination with germs, water companies add a disinfectant—usually either chlorine or chloramine —that kills disease-causing germs such s Salmonella, Campylobacter, and norovirus. The type of chloramine discussed on this page that is used to treat drinking water (monochloramine) is not the same type that can form and harm the indoor air quality around swimming pools (dichloramine or trichloramine) 2.chlorinechloramineSalmonellaCampylobacternorovirusdichloramine or trichloramine 2 – Today, chlorine and chloramine are the major disinfectants used to disinfect public water systems. (CDC)

40. What we know…Lead ■ We know that we have not found lead exceedences in source waters in South Carolina. ■ We know that corrosion inhibitors work to prevent lead in system pipes from getting into our drinking water. ■ We know that the simple act of allowing water to run first thing in the morning will remove the risk of lead exposure even for those who live in a house built prior to 1987 that has copper pipes with lead solder. 40

41. Provide Actionable Information ■ For home/business owners: – Flush home/business water lines each day before consuming the water. – Use cold water to cook, make coffee, etc. ■ For water systems: – Follow guidelines for adding corrosion inhibitors when needed. 41

42. Risk Communication Is Hard…Do It Anyway. “The single biggest problem in communication is the illusion that it has taken place.” – George Bernard Shaw

43. References: ■ Public Notification Rule. (n.d.). Retrieved March 22, 2016, from https://www.epa.gov/dwreginfo/public-notification-rule https://www.epa.gov/dwreginfo/public-notification-rule ■ Public Notification - Disinfection By-Products (DBP) Precursor Treatment Technique Template. (n.d.). Retrieved March 22, 2016, from https://www.epa.gov/region8-waterops/public-notification- disinfection-products-dbp-precursor-treatment-techniquehttps://www.epa.gov/region8-waterops/public-notification- disinfection-products-dbp-precursor-treatment-technique ■ Lead and Copper Rule. (n.d.). Retrieved March 22, 2016, from https://www.epa.gov/dwreginfo/lead-and-copper-rule https://www.epa.gov/dwreginfo/lead-and-copper-rule ■ Monitoring the Occurrence of Unregulated Drinking Water Contaminants. (n.d.). Retrieved March 22, 2016, from https://www.epa.gov/dwucmr https://www.epa.gov/dwucmr ■ CDC Healthy Drinking Water (2014). Retrieved March 22, 2016, from http://www.cdc.gov/healthywater/drinking/public/water_disinfe ction.html http://www.cdc.gov/healthywater/drinking/public/water_disinfe ction.html

44. The End “Never criticize someone until you have walked a mile in their shoes….that way, when you criticize them, you are a mile away AND you have their shoes.”