Invitation Letter

Attachment B

Invitation Letter

<State seal>

State, Department

Address

U nited States Department of the Interior

U. S. GEOLOGICAL SURVEY

New Hampshire - Vermont District

361 Commerce Way

Pembroke, New Hampshire 03275

National Center for Environmental Health

Centers for Disease Control and Prevention

4770 Buford Highway

Chamblee, GA 30341

XX, 2019

Dear Property Owner:

The <state, department> is working with the National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention and the U.S. Geological Survey (USGS) to understand exposure to arsenic and uranium from private well water.

<State> identified areas where there is no information about arsenic and/or uranium in well water in your area of the state. We want to test for the amount of arsenic and uranium in the water from 300 wells in your area. We are asking for your permission to collect and analyze a water sample from your private well.

Your participation in this investigation will greatly enhance our understanding of where arsenic and uranium are in the ground water that supplies private wells. For some homes, we will also ask that you provide a tap water sample, a urine specimen from one adult in the household, and answers to survey questions.

The data we collect will be summarized in a scientific report and will not include owner names or identifying information. You will receive the results of the analysis at no cost to you.

The USGS's Water Resources Division conducts scientific studies related to ground water and surface waters in the nation. We do not make or enforce laws; instead, our job is to provide unbiased and accurate scientific information to the people who make decisions about water resources.

Please look over these materials and consider being in this investigation. If you decide to be in the investigation, please sign the permission form and mail it to us in the enclosed postage-paid envelope. We would appreciate a response from you within 10 days of receipt. Once the permission form is returned, we will call you to answer any questions you may have and arrange an appointment to collect the sample(s).

Please feel free to contact us: Lorraine Backer (770) 488-3426, Joe Ayotte (603) 226-7810 or <State contact, phone number>. We can also be reached via email: [email protected] or [email protected], or <State contact e-mail).

Sincerely,

<State contact name>

COMMON QUESTIONS

 Why was my well chosen?

Your well is one of 100 private wells randomly selected from a database in this geographic area.

 What will this cost me?

Nothing. In fact, you will receive important information about the levels of arsenic and uranium in your well water. Arsenic and uranium tests typically costs about $200.00. As this is a large scientific study, it may take up to 12 months for you to receive your results. For more information on arsenic and uranium in drinking water contact:

<State, Department, phone number>

<website link>

 Where will we collect the well water sample?

The sample will be collected by trained personnel from a spigot near the pressure tank. The focus of this study is to assess the sources of drinking water in the state and therefore a goal is to collect water as close to the well as possible. If it is not feasible to access your pressure tank, we can also collect the water from an outside spigot if it is not treated water. At the time of water sample collection, USGS personnel will also collect a series of physical measurements such as pH and temperature.

 Where will we collect the tap water sample?

If we collect a tap water sample, it will be collected by trained personnel from your kitchen tap.

 Will you ask me to do any other activities?

Yes. We are doing an additional study to learn more about how arsenic in tap water relates to arsenic in urine. We will ask you about the second part of our study when we contact you about testing your well water.

 How will the information be used?

These data may be summarized in a scientific report, by geographic area, population density and other factors. No precise information pertaining to the well location or owner will be published; however, results may be disclosed as a result of Freedom of Information Act (FOIA) requests. Upon completion of the analysis, you will receive a copy of the results from the water sample.

Form Approved

OMB No. 0920-1173

Exp. Date 03/31/2020

RESPONSE FORM: PERMISSION TO COLLECT A WELL WATER SAMPLE

STUDY PARTICIPATION INFORMATION:

(please fill out both pages of this form)

________________________________________________________________________ Name (Please Print)

________________________________________________________________________

Street Address

______________________________________________________________________________ Mailing Address, if different

______________________________________________________________________________

City, State, Zip Code

_____________________ __________________________ __________________

Telephone number (Day) Telephone number (evening) Email

May we contact you at the daytime telephone number? YES _____ NO _____

Have you ever had your well water tested for arsenic and/or uranium? YES _____ NO _____

if YES, WHEN:____________ Results: ___________Arsenic

___________Uranium

What is the depth of your well? __________Ft.

CDC estimates the average public reporting burden for this collection of information as 5 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1173).

I (we) _____________________________________________ hereby give my (our) permission to the U.S. Geological Survey to collect a water sample(s) from my well or spring. I understand that this sample will be analyzed by the New Hampshire Department of Environmental Services Laboratory and that the data will be used for scientific purposes. I also understand that I will be given a copy of the results of the analysis. The U.S. Geological Survey will not release water system names or identifying information, except to the extent that it is required to do so by law. The U.S. Geological Survey has also informed me (us) that results may be disclosed as a result of Freedom of Information Act (FOIA) requests.

In addition to collecting a water sample(s) for a laboratory analysis, the U.S. Geological Survey may also make a series of concurrent physical measurements such as pH, specific conductance, and temperature.

If I (we) have any questions about this study, I can contact:

<State contact> at the following telephone XXX-XXX-XXXX

Denise Argue at the following telephone 603-226-7833 or

Joseph Ayotte at the following telephone 603-226-7810

__________________________________________ _________________

Signature, Permitter Date

________________________________________ __________________

Signature, U.S. Geological Survey Date

Local Address:

U.S. Geological Survey- NH/VT

361 Commerce Way

Pembroke, NH 03275

603-226-7800

603-226-7894 (Fax)