Application - Salinas Basin Stewards

Salinas Basin Agricultural Stewardship Group (SBASG)
Application for Bottled Water
Apply online at https://www.salinasbasinstewards.com/application/

The Salinas Basin Agricultural Stewardship Group (SBASG) is managing the Free Drinking Water Program, which provides water to residences located in Salinas Valley whose domestic supply well exceeds the nitrate standard for drinking water (10mg/L). SBASG is contracting with Culligan of Monterey County to supply 5-gallon containers of free water to qualified applicants. Please be aware that SBASG is required to publicly report well water sample results and well locations. Well water sample results and location will be shared under an anonymous identifying code in order to protect the privacy of participants. SBASG will not provide any information in this application to any local, state or federal agency involved with immigration enforcement.

Eligible applicants are:

Residences located in Salinas Valley Groundwater Basin whose domestic well has been verified to contain nitrate above the drinking water standard (A free water sample will be taken as part of this program);
Those who complete this application;
Those who sign a contract with a bottled water provider offered through this grant (specific details below).

Successful applicants will be provided with bottled water delivery by Culligan of Monterey County located in Salinas (at no cost to applicant). Applicant must sign a separate agreement with Culligan and comply with all Culligan’s contract terms and conditions. No costs will be incurred by any participant in this bottled water program.

Application must be filled in completely and submitted to SBASG. Incomplete applications will not be reviewed.

Applicant Contact Information
(Main contact for phone calls and correspondence about this application)

Bottled Water Application Residence

Applicant(s) Name(s) *

Is the applicant above the landowner? *

Yes

Address *

City *

State *

Zip *

Phone *

Secondary Phone

Email Address *

Landowner Contact Information - Optional (If different than above)

Landowner Name

Address

City

State

Zip

Phone

Email Address

Water Use Information

Water System Name *

If you share your well with other residences, then the well may be a Water System monitored by Monterey County. Please enter your Water System Name here. Enter ‘Unknown’ if you do not know the name or are unsure if your well is part of a Water System.

This is a: (Select One) *

Residence

Business

If residence, how many people in household?

If business, how many employees?

Full-time:

Part-time:

Language Preference: *

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