MDH Chemical Nomination Form

This form is for nominating contaminants to the Drinking Water Contaminants of Emerging Concern (CEC) initiative. The purpose of this form is to gather specific information on the contaminant and understand the nominator’s need for the chemical to be reviewed.

Please provide the following information, for each nominated chemical, if available. Be sure to submit specific, individual chemicals and not chemical groups such as “plastics” or “herbicides”. If nominating multiple chemicals, please fill out a separate form for each chemical.

For a list of chemicals with current MDH guidance, refer to our Health-Based Water Guidance Table (opens in a new window). For a list of chemicals that have already been nominated, refer to our Nominated Contaminants Status Table (PDF) (opens in a new window). Chemicals can be re-nominated, especially if new concerns have arisen or new information is available.

Information

Name

Affiliation (if applicable)

Telephone

Address

Chemical Identification

Chemical name

CASRN: Chemical Abstracts Service Registration Numbers (CASRNs) can be found at ChemIDplus (opens in a new window).

Why are you nominating this chemical?

Occurrence in Minnesota
Information regarding where, how frequently and at what concentrations a chemical has been found helps MDH prioritize nominations.
Do you have any occurrence information?

Has the chemical been detected in water?

Yes
No
Don't know

Are the detection's known to be related to a contamination site or source (e.g., Superfund site, landfill, manufacturing facility)?

Yes
No
Don't know

If detected in Minnesota, is the water used as a source of drinking water?

Yes
No
Don't know

Many societal factors, such as low income, discrimination, and reduced access to health care, may impact health equity as well as the magnitude of exposure to chemicals in the environment.
To your knowledge, has the nominated chemical been found in water supplies in areas where the population may be affected by these factors?

Toxicity Information Availability
Information on how toxic a chemical is or what health effects it causes helps MDH prioritize nominations.
Are you aware of any available toxicity information or information regarding health effects for this chemical?

Yes
No
Don't know

Please provide any information that you are aware of.

Potential Use/Impact of Guidance if it is Derived
If applicable, please explain the potential use or impact of derived guidance (e.g., use as a permit limit, evaluation of water monitoring data).

Additional Information
Provide any additional information that you feel would be useful for MDH to know regarding your nomination.

Prioritization of Multiple Nominations
If you are nominating more than one chemical, please provide a ranking of your nominations is order of highest to lowest priority.
(e.g., 1. chemical, 2. chemical, 3. chemical)

Please Note
MDH is not able to conduct a full review and/or develop health based guidance for every contaminant that is nominated. Please contact us with questions or comments at 651-201-4899 or health.risk@state.mn.us.

At the discretion of MDH, CEC staff will develop guidance for contaminants that are not nominated by an outside party and that are not assessed through a selection process. For more information on our selection process see CEC Nomination and Selection Process (opens in a new window).