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Home My WebLink AboutCONSENT Well inspection fee for service DOE ff 615 Sheridan Street Port Townsend, WA 98368 Ainson www.JeffersonCountyPublicHealth.org Consent Agenda Public Heat JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Josh D. Peters, County Administrator FROM: Carter Erickson, Environmental Health Manager Emma Erickson, Environmental Health Specialist II DATE: ,9&s f- 2 /, 24 SUBJECT: Agenda item — IAA No. C2600196 Between Washington State Department of Ecology and Jefferson County Public Health; July 1, 2026 — June 30, 2031; Inspection of all well construction and decommissioning within Jefferson County. STATEMENT OF ISSUE: Jefferson County Public Health (JCPH), Environmental Health Division, requests Board approval of Interagency Agreement (IAA) between Washington State Department of Ecology (Ecology) and JCPH for delegation and funds to JCPH to administer and enforce the well sealing, tagging, and decommissioning portions of the water well construction regulations within Jefferson County. ANALYSIS/STRATEGIC GOALS/PROS and CONS: This agreement replaces the expired IAA NO. C2200060 and continues like-for-like delegation from Ecology to JCPH. This IAA continues established program services provided by JCPH. FISCAL IMPACT/COST BENEFIT ANALYSIS: This agreement reestablishes reliable funding to the department's well inspection program. Ecology will pay JCPH fifty percent (50%) of the well construction fees and fifty percent (50%) decommissioning fees collected by Ecology for water wells constructed and decommissioned in Jefferson County during the Agreement's period of performance, all payments shall be made to JCPH after quarterly reports received by Ecology. RECOMMENDATION: JCPH management requests approval of IAA No. C2600196 Between Washington State Department of Ecology and Jefferson County Public Health; July 1, 2026 — June 30, 2031; Inspection of all well construction and decommissioning within Jefferson County. REVIEWED BY: 4°1(3 q( (qblel Josh D. eters, County Administrator Date Community Health Environmental Public Health Developmental Disabilities 360-385-9444 360-385-9400 (f) 360-379-4487 360-385-9401 (f) Always working for a safer and healthier community EH-26-063 CONTRACT REVIEW FORM I Clear Form I (INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: WA Dept of Ecology Contract No: EH-26-063 Contract For: Well delegation Term: 7/1/2026 - 6/30/2031 COUNTY DEPARTMENT: Environmental Health Contact Person: Carter Erickson Contact Phone: x 303 Contact email: cerickson@co.jefferson.wa.us AMOUNT: Fee for service PROCESS: if Exempt from Bid Process Revenue: Cooperative Purchase Expenditure: Competitive Sealed Bid Matching Funds Required: Small Works Roster Sources(s) of Matching Funds Vendor List Bid Fund # RFP or RFQ Munis Org/Obj Other: APPROVAL STEPS: STEP 1: DEPARTMENT CERTIFIES COMP IA}1 WI J .080 ND CHAPTER 42.23 RCW. CERTIFIED: t l N/A: l / August 10, 2026 Glenn Gilbert Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT BEE, DEBAR BY ANY FEDERAL, STATE, OR LOCAL AGENCY. /� i% CERTIFIED: fl N/A: August 10, 2026 Glenn tlbert Date STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche): Electronically approved by Risk Management on 8/17/2026. STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche): Electronically approved as to form by PAO on 8/14/2026. DPA Luther reviewed and approved on 8-14-2026. STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY(IF REQUIRED). STEP 6: CONTRACTOR SIGNS STEP 7: SUBMIT TO BOCC FOR APPROVAL r .3111 64:01 DEPARTMENT OF ECOLOGY State of Washington IAA No. C2600196 INTERAGENCY AGREEMENT (IAA) BETWEEN THE STATE OF WASHINGTON, DEPARTMENT OF ECOLOGY AND JEFFERSON COUNTY PUBLIC HEALTH THIS INTERAGENCY AGREEMENT("Agreement" or"IAA") is made and entered into by and between the state of Washington, Department of Ecology, hereinafter referred to as "ECOLOGY," and the JEFFERSON COUNTY PUBLIC HEALTH, hereinafter referred to as the "JCPH" or"CONTRACTOR," pursuant to the authority granted by Chapter 39.34 of the Revised Code Washington, Interlocal Cooperation Act. THE PURPOSE OF THIS AGREEMENT is to provide the delegation and funds to JCPH to administer and enforce the well sealing,tagging, and decommissioning portions of the water well construction regulations. WHEREAS, ECOLOGY has legal authority (WAC 173-160) entitled Minimum Standards for Construction and Maintenance of Wells and JCPH has legal authority (RCW 18.104) entitled the Washington Well Construction Act, that allows each party to undertake the actions in this agreement. WHEREAS,JCPH shall implement the provisions of the well tagging, sealing, and decommissioning components of Chapter 173-160 WAC. Authority for this action of delegation and funding is provided through the provisions of RCW 18.104.043 and 18.104.150. Delegation of authority to inspect wells applies only to water supply wells. THEREFORE, IT IS MUTUALLY AGREED THAT: 1 Version 4/14/2025 JeffCo:EH-26-063 State of Washington, Department of Ecology IAA No. C2600196 Entity Name:Jefferson County Public Health 1. SCOPE OF WORK JCPH shall furnish the necessary personnel, equipment, material and/or service(s) and otherwise do all things necessary for or incidental to the performance of the work set forth in Appendix A,Statement of Work, attached hereto and incorporated herein. 2. PERIOD OF PERFORMANCE The period of performance of this IAA will commence on July 1, 2026, and be completed by June 30, 2031, unless the Agreement is terminated sooner as provided herein. Amendments extending the period of performance, if any, shall be at the sole discretion of ECOLOGY. 3. PAYMENT Funding provided to JCPH by ECOLOGY is authorized under the provisions of RCW 18.104.150. ECOLOGY shall pay JCPH for services described as follows: Amount: fifty percent (50%) of the notification fees collected for water wells constructed and fifty percent (50%) of the notification fees collected for water wells decommissioned within Jefferson County during the time period covered by this Agreement. ECOLOGY may, at its sole discretion, terminate or suspend this Agreement, or withhold payments claimed by the CONTRACTOR for services rendered, if the CONTRACTOR fails to satisfactorily comply with any term or condition of this Agreement. 4. BILLING AND PAYMENT PROCEDURE ECOLOGY will pay JCPH fifty percent (50%) of the well construction fees and fifty percent (50%) decommissioning fees collected by ECOLOGY for water wells constructed and decommissioned in Jefferson County during the Agreement's period of performance, all payments shall be made to JCPH after quarterly reports received by ECOLOGY. Payment will be issued through Washington State's Office of Financial Management's Statewide Payee Desk. To receive payment, CONTRACTOR must register as a statewide vendor by submitting a statewide vendor registration form and an IRS W-9 form at website, https://ofm.wa.gov/it-systems/statewide- vendorpayee-services. For questions about the vendor registration process, contact Statewide Payee Help Desk at(360) 407-8180 or email PayeeRegistration@ofm.wa.gov. 5. ALTERATIONS AND AMENDMENTS This Agreement may be amended by mutual agreement of the parties. Such amendments shall not be binding unless they are in writing and signed by personnel authorized to bind each of the parties. 6. ASSIGNMENT The work to be provided under this Agreement, and any claim arising thereunder, is not assignable or delegable by either party in whole or in part, without the express prior written consent of the other party, which consent shall not be unreasonably withheld. 2 Version 4/14/2025 State of Washington, Department of Ecology IAA No. C2600196 Entity Name:Jefferson County Public Health 7. ASSURANCES Parties to this Agreement agree that all activity pursuant to this agreement will be in accordance with all the applicable current federal, state, and local laws, rules, and regulations. 8. CONFORMANCE If any provision of this Agreement violates any statute or rule of law of the state of Washington, it is considered modified to conform to that statute or rule of law. 9. DISPUTES Parties to this Agreement shall employ every effort to resolve a dispute themselves without resorting to litigation. In the event that a dispute arises under this Agreement that cannot be resolved among the parties, it shall be determined by a Dispute Board in the following manner. Each party to this Agreement shall appoint one member to the Dispute Board. The members so appointed shall jointly appoint an additional member to the Dispute Board. The Dispute Board shall review the facts, agreement terms, and applicable statutes and rules, and then make a determination of the dispute. The determination of the Dispute Board shall be final and binding on the parties hereto, unless restricted by law. The cost of resolution will be borne by each party paying its own cost. As an alternative to this process, if state agencies, either of the parties may request intervention by the Governor, as provided by RCW 43.17.330, in which event the Governor's process will control. The parties may mutually agree to a different dispute resolution process. 10. FUNDING AVAILABILITY ECOLOGY's ability to make payments is contingent on availability of funding. In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after the effective date and prior to completion or expiration date of this Agreement, ECOLOGY, at its sole discretion, may elect to terminate the Agreement, in whole or part, for convenience or to renegotiate the Agreement subject to new funding limitations and conditions. ECOLOGY may also elect to suspend performance of the Agreement until ECOLOGY determines the funding insufficiency is resolved. ECOLOGY may exercise any of these options with no notification restrictions, although ECOLOGY will make a reasonable attempt to provide notice. In the event of termination or suspension, ECOLOGY will reimburse eligible costs incurred by the CONTRACTOR through the effective date of termination or suspension. Reimbursed costs must be agreed to by ECOLOGY and the CONTRACTOR. In no event shall ECOLOGY's reimbursement exceed ECOLOGY's total responsibility under the agreement and any amendments. 11. GOVERNING LAW AND VENUE This Agreement is entered into pursuant to and under the authority granted by the laws of the state of Washington and any applicable federal laws. The provisions of this Agreement shall be construed to conform to those laws. This Agreement shall be construed and interpreted in accordance with the laws of the state of Washington, and the venue of any action brought hereunder shall be the Superior Court for Thurston County. 3 Version 4/14/2025 State of Washington, Department of Ecology IAA No.C2600196 Entity Name:Jefferson County Public Health 12. INDEPENDENT CAPACITY The employees or agents of each party who are engaged in the performance of this Agreement shall continue to be employees or agents of that party and shall not be considered for any purpose to be employees or agents of the other party. 13. ORDER OF PRECEDENCE In the event of an inconsistency in the terms of this Agreement, or between its terms and any applicable statute or rule,the inconsistency shall be resolved by giving precedence in the following order: a. Applicable federal and state of Washington statutes, regulations,and rules. b. Mutually agreed upon written amendments to this Agreement. c. This Agreement, number C2600196. d. Appendix A,Statement of Work. e. Appendix B,Special Terms and Conditions f. Appendix C, Well Construction and Decommissioning Quarterly Report Form. g. Any other provisions or term of this Agreement, including materials incorporated by reference or otherwise incorporated. 14. RECORDS MAINTENANCE The parties to this Agreement shall each maintain books, records, documents,and other evidence that sufficiently and properly reflect all direct and indirect costs expended by either party in the performance of the service(s)described herein. These materials shall be subject to inspection, review,or audit by personnel of both parties, other personnel duly authorized by either party,the Office of the State Auditor, and federal officials so authorized by law. All books, records,documents, and other materials relevant to this Agreement must be retained for six years after expiration of this Agreement.The Office of the State Auditor, federal auditors,and any persons duly authorized by the parties shall have full access and the right to examine any of these materials during this period. Each party will utilize reasonable security procedures and protections for all materials related to this Agreement. All materials are subject to state public disclosure laws. 15. RESPONSIBILITIES OF THE PARTIES Each party of this Agreement hereby assumes responsibility for claims and/or damages to persons and/or property resulting from any act or omissions on the part of itself, its employees, its officers, and its agents. Neither party will be considered the agent of the other party to this Agreement. 16. RIGHTS IN DATA Unless otherwise provided,data which originates from this Agreement shall be "work made for hire" as defined by the United States Copyright Act,Title 17 U.S.C. section 101 and shall be owned by state of Washington, ECOLOGY. Data shall include, but not be limited to, reports,documents, pamphlets, advertisements, books magazines, surveys,studies, computer programs, films, tapes, and/or sound reproductions. Ownership includes the right to copyright, patent, and register these items, and the ability to transfer these rights. 4 Version 4/14/2025 State of Washington, Department of Ecology IAA No.C2600196 Entity Name:Jefferson County Public Health 17. SEVERABILITY If any provision of this Agreement or any provision of any document incorporated by reference shall be held invalid, such invalidity shall not affect the other provisions of this Agreement which can be given effect without the invalid provision, if such remainder conforms to the requirements of applicable law and the fundamental purpose of this Agreement, and to this end the provisions of this Agreement are declared to be severable. 18. SUBCONTRACTORS a. CONTRACTOR agrees to take complete responsibility for all actions of any Subcontractor used under this Agreement for the performance. When federal funding is involved there will be additional CONTRACTOR and subcontractor requirements and reporting. Prior to performance,all subcontractors who will be performing services under this Agreement must be identified, including their name,the nature of services to be performed,address, telephone, WA State Department of Revenue Registration Tax number(UBI),federal tax identification number(TIN), and anticipated dollar value of each subcontract. Identify whether subcontractor is certified with Office of Minority and Women's Business Enterprises(OMWBE), WA Dept. of Veterans Affairs (WDVA), or is a WA small business. Provide such information to ECOLOGY's Agreement representative. b. Subcontractor Payment Reporting Requirements—Access Equity: This Agreement is subject to compliance tracking of subcontractor(s) spend using the State's business diversity management system, Access Equity(B2Gnow). Access Equity is web-based and can be accessed at the Office of Minority and Women's Business Enterprises(OMWBE)at https://omwbe.diversitycompliance.com/.The Contractor and all Subcontractor(s) shall report and confirm receipt of payments made to the Contractor and each Subcontractor through Access Equity. The Contractor may contact Shanyese Trujillo, Shanyese.Trujillo@ecy.wa.gov for technical assistance in using the Access Equity system. Changes to the contact information may be communicated to the CONTRACTOR by email,and does not require an amendment. User guides and documentation related to Contractor and Subcontractor access to and use of Access Equity are available online at https://omwbe.wa.gov/access-equity-help-center. ECOLOGY reserves the right to withhold payments from the Contractor for non-compliance with this section. For purposes of this section,Subcontractor means any subcontractor working on the Agreement, at any tier and regardless of status as certified WMBE or Non-WMBE. The Contractor shall: a. Register and enter all required Subcontractor information into Access Equity no later than fifteen (15) days after ECOLOGY creates the file (Contract Record) in Access Equity. b. Complete the required user training(two (2)one-hour online sessions) no later than twenty (20) days after ECOLOGY creates the file (Contract Record) in Access Equity. c. Report the amount and date of all payments i. received from ECOLOGY, and 5 Version 4/14/2025 State of Washington, Department of Ecology IAA No.C2600196 Entity Name:Jefferson County Public Health ii. paid to Subcontractors, no later than fifteen (15) days after the issuance of each payment made by ECOLOGY to the Contractor, unless otherwise specified in writing by ECOLOGY, except that the Contractor shall mark as "Final"and report the final Subcontractor payments into Access Equity no later than thirty(30)days after the final payment is due the Subcontractor(s) under the Agreement, with all payment information entered no later than sixty(60) days after end of fiscal year,June 30. d. Monitor Agreement payments and respond promptly to any requests or instructions from ECOLOGY or system-generated messages to check or provide information in Access Equity. e. Coordinate with Subcontractors,or ECOLOGY,when necessary,to resolve promptly any discrepancies between reported and received payments. f. Require each Subcontractor to: i. register in Access Equity and complete the required user training. ii. verify the amount and date of receipt of each payment from the Contractor or a higher tier Subcontractor, if applicable, through Access Equity. iii. report payments made to any lower tier Subcontractors, if any, in the same manner as specified herein. iv. respond promptly to any requests or instructions from the Contractor or system- generated messages to check or provide information in Access Equity; and v. coordinate with Contractor, or ECOLOGY, when necessary,to resolve promptly any discrepancies between reported and received payments. 19. SUSPENSION FOR CONVENIENCE ECOLOGY may suspend this Agreement or any portion thereof for a temporary period by providing written notice to the CONTRACTOR a minimum of seven (7) calendar days before the suspension date. CONTRACTOR shall resume performance on the first business day following the suspension period unless another day is specified in writing by ECOLOGY prior to the expiration of the suspension period. 20. TERMINATION FOR CAUSE If for any cause, either party does not fulfill in a timely and proper manner its obligations under this Agreement,or if either party violates any of these terms and conditions, the aggrieved party will give the other party written notice of such failure or violation. The responsible party will be given the opportunity to correct the violation or failure within fifteen (15) business days. If failure or violation is not corrected,this Agreement may be terminated immediately by written notice of the aggrieved party to the other. 21. TERMINATION FOR CONVENIENCE Either party may terminate this Agreement without cause upon thirty(30) calendar day prior written notification to the other party. If this Agreement is so terminated,the parties shall be liable only for performance rendered or costs incurred in accordance with the terms of this Agreement prior to the effective date of termination. 22. WAIVER A failure by either party to exercise its rights under this Agreement shall not preclude that party from subsequent exercise of such rights and shall not constitute a waiver of any other rights under this 6 Version 4/14/2025 State of Washington, Department of Ecology IAA No. C2600196 Entity Name:Jefferson County Public Health Agreement unless stated to be such in a written amendment to this Agreement signed by an authorized representative of the parties. 23. AGREEMENT MANAGEMENT The representative for each of the parties shall be responsible for and shall be the contact person for all communications, notifications, and billings questions regarding the performance of this Agreement. The parties agree that if there is a change in representatives, they will promptly notify the other party in writing of such change, such changes do not need an amendment. The ECOLOGY Representative is: The JCPH Representative is: Name: Scott Malone Name: Emma Erickson Address: PO Box 47600 Address: 615 Sheridan St Olympia, WA 98504-7600 Port Townsend,WA 98368 Phone: (360)407-6648 Phone: (360) 385-9407 Email: Scott.Malone@ecy.wa.gov Email: eerickson@co.jefferson.wa.us 7 Version 4/14/2025 State of Washington, Department of Ecology IAA No. C2600196 Entity Name:Jefferson County Public Health 24. ALL WRITINGS CONTAINED HEREIN This Agreement contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any of the parties hereto. The signatories to this Agreement represent that they have the authority to bind their respective organizations to this Agreement. IN WITNESS WHEREOF,the parties below, having read this Agreement in its entirety, including all attachments, do agree in each and every particular as indicated by their signatures below. State of Washington Jefferson County Washington Department of Ecology Dba Jefferson County Public Health By: By: Ria Berns Date Greg Brotherton, Chair Date Water Resources Program Manager Board of County Commissioners APPROVED ASTO FORM ONLY: �It- 8-13-2026 Jeremiah Luther, Date Civil Deputy Prosecuting Attorney Recommen g approva Glenn Gilbert, Date Public Health Assistant 8 Version 4/14/2025 State of Washington, Department of Ecology IAA No.C2600196 Entity Name:Jefferson County Public Health APPENDIX A STATEMENT OF WORK JCPH shall implement the provisions of the well tagging, sealing, and decommissioning components of Chapter 173-160 WAC. Authority for this action of delegation and funding is provided through the provisions of RCW 18.104.043 and 18.104.150.Delegation of authority to inspect wells applies only to water supply wells. A. JCPH shall inspect: • A minimum of fifty percent(50%) of water wells being drilled annually in Jefferson County for proper sealing and tagging; and • A minimum of ninety percent (90%) of wells being decommissioned annually in Jefferson County. B. JCPH shall at a minimum, conduct twenty-five percent(25%) of all their inspections while the driller is on-site.This percentage may be adjusted by ECOLOGY's contract manager for driller "no shows". C. JCPH shall administer and enforce the provisions of Chapter 173-160 WAC, Sections: 173-160- 101, 173-160-181, 173-160-221, 173-160-231, 173-160-241, 173-160-251, 173-160-261, 173- 160-271, 173-160-311, 173-160-381, and any subsequent revisions. D. This Agreement does not preclude ECOLOGY from enforcing these aforementioned regulations in Jefferson County. E. This Agreement does not preclude JCPH from adopting their own well construction rules or charging additional fees for well inspections. Deliverables:JCPH shall submit a quarterly report to ECOLOGY which summarizes the well drilling activities for that reporting period. See Appendix B Special Terms and Conditions and Appendix C Well Construction and Decommissioning Quarterly Report Form for additional deliverables. The quarterly report shall be submitted on the form provided by ECOLOGY and shall include the number of well construction and decommissioning notes received by JCPH as well as the number of inspections made.The report shall indicate if the driller was present during the inspection and if the driller was a "no show" at the scheduled time of inspection. Upon request, an additional detailed report shall itemize (at a minimum)the dates of inspection, notice of intent number,well tag number,well owner, drilling company,and driller.The report will also identify any enforcement activities,and any variances issued. Due Date: Quarterly reports are due on January 20th,April 20th,July 20th, and October 20th for inspections done in the prior three-month period. 9 Version 4/14/2025 State of Washington, Department of Ecology IAA No.C2600196 Entity Name:Jefferson County Public Health APPENDIX B SPECIAL TERMS AND CONDITIONS EDUCATIONAL REQUIREMENT FOR JCPH INSPECTIONS JCPH will ensure that inspectors will have the following minimum qualifications. 1. A Bachelor's degree from an accredited college or university involving major study in environmental health, sanitary science, bacteriology or public health,or other closely related science field. On the job experience with a health jurisdiction involving environmental health related work may be substituted year for year for the college education, including substituting for the requirement of a Bachelor's degree. Experience obtained through military service may be substituted year-for-year for up to two (2)years of college education. 2. Demonstrated written and oral communication skills. 3. Ability to establish and maintain professional and cooperative relationships with the public, state and federal agency personnel,and county personnel. 4. Physical capability to work outdoors under inclement weather conditions and climbing over rough terrain. 5. Valid Washington State driver's license and a vehicle adequate for daily use on the job. DESIRED QUALIFICATIONS FOR JCPH INSPECTIONS 1. Registration as a Sanitarian with the Washington State Board of Registered Sanitarians or National Environmental Health Association, or eligibility for registration in either. 2. Registration as a Professional Engineer, Geologist, Hydrogeologist, or Engineering Geologist. 3. Experience in operation and maintenance of groundwater monitoring equipment. TRAINING FOR JCPH INSPECTIONS ECOLOGY shall provide training for JCPH inspectors in well sealing,tagging, and decommissioning techniques.Training will focus on enforcement,data collection techniques,field investigations,well construction,and an overview of all applicable laws and regulations pertaining to this Agreement. New inspectors will be trained by ECOLOGY and JCPH. Each new inspector shall be required to complete a minimum of eight hours of classroom instruction provided by ECOLOGY.Twenty-eight hours of field instruction shall be provided by the combined resources of ECOLOGY and JCPH.JCPH shall provide adequate time and funding for inspectors to attend this training. All JCPH inspectors will be required to obtain two (2) one-hour Continuing Education Units(CEUs) per year in Washington State well construction rules and regulations.These CEUs will be available at the request of the JCPH via web conference or in-person meetings. If JCPH inspectors cannot travel outside local areas, ECOLOGY staff may travel to the JCPH or to a nearby location where several counties can be trained at one time. CEUs will be tracked by the ECOLOGY project manager. 10 Version 4/14/2025 State of Washington, Department of Ecology IAA No.C2600196 Entity Name:Jefferson County Public Health TECHNICAL AND ENFORCEMENT SUPPORT ECOLOGY shall provide technical and enforcement support throughout the term of this Agreement.The primary point of contact for technical and enforcement assistance will be the Well Construction and Licensing Program Coordinator(360)407-6648. VIOLATIONS PROCEDURES JCPH shall supply ECOLOGY with a copy of their enforcement procedures relating to the delegated items of this Agreement within ninety(90)days from signing. Violations identified by JCPH which are not covered by this Agreement shall be reported to ECOLOGY's Southwest Regional Office(360)407-0297.Verbal notification of these types of violations shall be given within 24 hours.To facilitate ECOLOGY's role in future enforcement actions, written documentation of suspected violations may be required and will be evaluated by ECOLOGY on a case-by-case basis. Specific enforcement procedures will be included in the basic training instructions. ANNUAL REVIEW JCPH and ECOLOGY shall review and evaluate the terms of this Agreement annually upon a mutually agreed month.At a minimum,the evaluation must include an audit of construction inspections, decommissioning inspections, enforcement activities,variances, and other driller interactions that occurred during the year.The evaluation will also address the need to update or otherwise change portions of this Agreement, changes will be handled via amendment. ECOLOGY shall prepare a report of the findings.The report shall be made available via the internet or upon request. 11 Version 4/14/2025 State of Washington, Department of Ecology IAA No. C2600196 Entity Name:Jefferson County Public Health APPENDIX C WELL CONSTRUCTION AND DECOMMISSIONING QUARTERLY REPORT FORM County Name: Contact phone number: Person reporting: Contact email: Year: Quarter: E JAN - MAR (due Apr 20th) ❑ APR -JUN (due July 20th) ❑JUL- SEP (due Oct 20th) E OCT- DEC (due Jan 20th) Well Construction Number Reports of new(and alteration of existing)wells Number called-in county New wells(and alteration of existing) inspected at least once First inspection only Total number of well inspections Could be more than one inspection per well call-in • Wells inspected with driller present Interaction with driller is encouraged • Planned well inspections with driller absent Well Decommissioning Number Reports of new(and alteration of existing)wells Number called-in county New wells(and alteration of existing) inspected at least once First inspection only Total number of well inspections Could be more than one inspection per well call-in Wells inspected with driller present Interaction with driller is encouraged Planned well inspections with driller absent Ecology Contact: Scott A. Malone Well Construction and Licensing Coordinator Phone (360) 407-6648 Send completed form to: Email: scma461@ecy.wa.gov Mail: Department of Ecology Well Construction Unit PO Box 47600 FAX(with cover sheet): (360)407-7162 Olympia, WA 98504-7600 ECY 070-529(Revised 04/16)) To request ADA accommodation including materials in a format for the visually impaired,call Ecology Water Resources Program at 360-407-6872. Persons with impaired hearing may call Washington Relay Service at 711. Persons with speech disability may call TTV at 877-833-6341. 12 Version 4/14/2025