+/- Alabama

• Statute
  Code of Ala. 1975, § 22-23-21
  “(a) A public water system, as defined in Section 22-23-31, that proposes to initiate any permanent change in the fluoridation status of its water supply, including, but not limited to, discontinuing the fluoridation of the water supply or reducing the level of fluoride from an optimal level as defined by the Centers for Disease Control and Prevention, shall provide written notice to the State Health Officer no fewer than 90 days before initiating the change. Notice shall include the proposed date of the change, reasons for the change, and all communities affected by the change. (b) A public water system that fails to meet the notification requirements of subsection (a) shall resume the fluoridation of its water supply to its previous level until proper notice is provided to the State Health Officer. (c) The notification requirements of subsection (a) do not apply to a temporary discontinuance of fluoridation that is caused by equipment failure, maintenance, or replacement; temporary chemical supply shortages; placing water sources offline; or other similar unavoidable circumstances.”
• Regulation
  Ala. Admin. Code r. 335-7, Appendix C, Health Effect and Required Language for Specific Contaminants; Ala. Admin. Code r. 335-7-2-21, Public Notification.

+/- Alaska

• Statute
  None
• Regulation
  Alaska Administrative Code, Title 18, § 80.315 Inorganic chemical sampling requirements.

+/- Arizona

• Statute
  None
• Regulation
  None

+/- Arkansas

• Statute
  Ark. Code Ann. § 20-7-136
  "“(a) As used in this section, “water system” means a facility including without limitation a parent system, consecutive system, or other system that holds, treats, and supplies water directly or through a consecutive system or consecutive systems to five thousand (5,000) persons or more. (b) The company, corporation, municipality, county, government agency, or other entity that owns or controls a water system shall control the quantity of fluoride in the water so as to maintain a fluoride content established by the Department of Health. (c) The State Board of Health shall adopt rules relating to the fluoridation of water systems that shall include without limitation: (1) Permissible concentrations of fluoride to be maintained by a water system; and (2) Requirements and procedures for maintaining permissible concentrations of fluoride including without limitation: (A) Necessary equipment; (B) Recordkeeping; (C) Reporting; and (D) Testing. (d)(1) A water system required to fluoridate under this section is not required to comply with the requirements of this section until funds sufficient to pay capital start-up costs for fluoridation equipment for the system have become available from any source other than tax revenue or service revenue regularly collected by the company, corporation, municipality, county, or other government agency that owns or controls the water system. (2) A licensed civil engineer recognized or employed by the department who is familiar with the design, construction, operation, and maintenance of fluoridation systems shall determine for the department whether the capital start-up costs claimed under subdivision (d)(1) of this section are reasonable. (e) A water system for a city in this state that receives its water supply from a community in another state is not required to comply with this section until a substantially similar fluoridation program is enacted for the water system of the community in the other state.” “Every owner must operate the water supply, including water treatment plant and distribution system, so as to meet the standards set forth in the National Primary Drinking Water Regulations, and take every reasonable precaution to protect the water from contamination. Every owner of a surface water system must operate the treatment facility within the operating criteria specified at the time of approval by the Arkansas Department of Health, or as specified in writing to the owner by the Arkansas Department of Health at any time following the approval. (See also Section XXI.) A. Monitoring For purposes of determining compliance with the National Drinking Water Regulations, the Arkansas Department of Health Laboratory will be used unless otherwise approved by the Arkansas Department of Health. The Arkansas Department of Health may, by using a published policy, signed by the Director of the Department, and approved by the U.S. Environmental Protection Agency, utilize any discretion allowed in the National Primary Drinking Water Regulations for monitoring requirements or for Maximum Contaminant Level or Treatment Technique compliance. B. Records The owner shall make such suitable analyses and keep such records of operation as required by the Arkansas Department of Health. True and accurate reports of such analyses and operational records for each month shall be submitted to the Arkansas Department of Health by the tenth day of the following month. (See also Section XVII.) Unless a longer record retention period is specified elsewhere or required by the National Primary Drinking Water Regulations, all records including analyses results, reports, forms, charts, daily logs, and electronic files shall be retained for a minimum of three (3) years and shall be made available for review if requested. C. Responsibility Every owner or their agents shall be responsible for compliance with these Regulations and shall submit samples of water to the Arkansas Department of Health Laboratory whenever requested by the Arkansas Department of Health. Such samples must be representative of the water in the system and must not be tampered with in any manner which may affect the analytical results. D. License The owner of any community public water system, non-transient non-community public water system, or any other non-community public water system which utilizes a surface water or surface water influenced source shall utilize water operators duly licensed under the provisions of Act 333 of 1957, as amended, and such Rules and Regulations as may be adopted under the provisions of Act 333 of 1957 as amended. (See Arkansas Code Annotated § 17-51-101 et seq) The owner shall place the direct supervision of the water system under an available Water Operator(s) in Responsible Charge holding a valid license equal to or greater than the classification of the treatment facility and/or distribution facility. E. Cross-Connection Program The owner shall institute a routine cross-connection program to locate and eliminate cross-connections. The program shall include routine inspections of commercial and industrial establishments and the routine maintenance of a listing of locations of cross-connection control devices. Each program shall include the mandatory testing of backflow prevention devices by certified testers, on a frequency approved by the Arkansas Department of Health. F. Fluoridation 1. Application In accordance with Act 197 of 2011 (§ 20-7-136), the owner of a public water system that produces and treats raw water and that directly or through a consecutive system or systems supplies five thousand (5,000) persons or more shall implement a fluoridation program so as to maintain an optimum fluoride concentration in the water. For such systems and for any public water system that controls the fluoride concentration, the optimum concentration shall be 0.7 milligrams per liter with a control range of 0.6 milligrams per liter to 1.2 milligrams per liter. 2. Equipment, testing and reporting A public water system that controls the fluoride concentration shall comply with the applicable sections of this regulation. In addition, such public water systems shall comply with the fluoride equipment, record keeping, testing, reporting and related requirements identified as a “must” for Community Public Water Systems contained in Sections II, III, and IV of Engineering and Administrative Recommendations for Water Fluoridation, 1995, Centers for Disease Control and Prevention, except that entry point rather than distribution system monitoring shall be utilized for measuring the fluoride concentration. Other exceptions on a case-by-case basis may be allowed but only as specified in writing by the Arkansas Department of Health. 3. Compliance Pursuant to § 20-7-136 (d) and (e), implementation of a fluoridation program is not required: 1) until funds sufficient to pay capital start-up costs for fluoridation equipment for the system have become available from any source other than tax revenue or service revenue collected by the water system or the entity which owns or controls it; or 2) for a water system in this state that receives its water from a community in another state until a substantially similar fluoridation program is enacted in the other state. Reasonable items for fluoridation start-up include those indispensible to the proper and safe addition and handling of fluoride compounds such as piping, feeder, chemical storage, safety, testing and related equipment and facilities.” "
• Regulation
  Ark. Admin. Code 007.18.2-VII Operation

+/- California

• Statute
  Cal. Health & Safety Code §116409 Legislative findings and declarations; protection and maintenance of dental health; Cal. Health & Safety Code §116410 Public water systems of at least 10,000 service connections not meeting minimum natural fluoride levels; regulation of fluoridation of systems; capital costs estimates; exemption from provisions; Cal. Health & Safety Code § 116415 Exemption for certain public water systems from application of Section 116410; annual list of nonexempt water systems; department authority to enforce; mandamus where noncompliance by owner or operator; funding for enforcement; rate increases to cover costs.
  “The Legislature finds and declares all of the following: (a) Promotion of the public health of Californians of all ages by protection and maintenance of dental health through the fluoridation of drinking water is a paramount issue of statewide concern. (b) It is the intent of the Legislature in enacting this article to preempt local government regulations, ordinances, and initiatives that prohibit or restrict the fluoridation of drinking water by public water systems with 10,000 or more service connections, without regard to whether the public water system might otherwise be exempt from Section 116410 or the requirements of this section, pursuant to Section 116415. (c) It is further the intent of the Legislature in establishing this article to decrease the burden the Medi-Cal and the Denti-Cal programs place upon the state's limited funds.” Cal. Health & Safety Code § 116409. “(a) Each public water system with at least 10,000 service connections and with a natural level of fluorides that is less than the minimum established in the regulations adopted pursuant to this section shall be fluoridated in order to promote the public health of Californians of all ages through the protection and maintenance of dental health, a paramount issue of statewide concern. The department shall adopt regulations pursuant to Chapter 3.5 (commencing with Section 11340) of Division 3 of Title 2 of the Government Code, requiring the fluoridation of public water systems. By July 1, 1996, and at 10-year intervals thereafter, each public water system with at least 10,000 service connections shall provide to the department an estimate of the total capital costs to install fluoridation treatment. The regulations adopted by the department shall take effect on January 1, 1997. Capital costs estimates are no longer required after installation of the fluoridation treatment equipment. (b) The regulations shall include, but not be limited to, the following: (1) Minimum and maximum permissible concentrations of fluoride to be maintained by fluoridation of public water systems. (2) The requirements and procedures for maintaining proper concentrations of fluoride, including equipment, testing, recordkeeping, and reporting. (3) Requirements for the addition of fluorides to public water systems in which the natural level of fluorides is less than the minimum level established in the regulations. (4) A schedule for the fluoridation of public water systems with at least 10,000 service connections, based on the lowest capital cost per connection for each system. (c) The purpose of the schedule established pursuant to paragraph (4) of subdivision (b) is not to mandate the order in which public water systems receiving funding from private sources must fluoridate their water. Available funds may be offered to any system on the schedule. (d) The estimates provided to the department pursuant to subdivision (a) of this section and subdivision (g) of Section 116415 of the total capital and associated costs and noncapital operation and maintenance costs related to fluoridation treatments and the similar estimates provided to those sources offering to provide the funds set forth in paragraph (1) of subdivision (a) of Section 116415 shall be reasonable, as determined by the department. A registered civil engineer recognized or employed by the department who is familiar with the design, construction, operation, and maintenance of fluoridations systems shall determine for the department whether the costs are reasonable. (e) As used in this section and Section 116415, “costs” means only those costs that require an actual expenditure of funds or resources, and do not include costs that are intangible or speculative, including, but not limited to, opportunity or indemnification costs. (f) Any public water system with multiple water sources, when funding is not received to fluoridate all sources, is exempt from maintaining otherwise required fluoridations levels in areas receiving any nonfluoridated water. The exemption shall be in effect only until the public water system receives funding to fluoridate the entire water system and the treatment facilities are installed and operational.” Cal. Health & Safety Code § 116410.
• Regulation
  Cal. Admin. Code, title 22 § 64433 System Requirements and Exemptions; Cal. Admin. Code, title 22 § 64433.2. Optimal Fluoride Levels; Cal. Admin. Code, title 22 § 64433.3 Monitoring and Compliance - Fluoride Levels; Cal. Admin. Code, title 22 § 64433.5 Fluoridation System; Cal. Admin. Code, title 22 § 64433.7 Recordkeeping, Reporting, and Notification for Water Systems Fluoridating; Cal. Admin. Code, § 64433.8. Fluoridation System Operations Contingency Plan.

+/- Colorado

• Statute
  C.R.S.A. § 25-21.5-102 Legislative declaration
  “(1) The general assembly hereby finds and declares that: (a) Statewide, students miss seven million eight hundred thousand school hours each year due to oral pain. Nationwide, workers miss one hundred sixty-four million work hours each year due to dental issues. (b) Forty percent of children in kindergarten and fifty-five percent of children in third grade have a history of dental decay. (c) Children in low-income schools have twice as much untreated tooth decay and are twice as likely to have a history of cavities than children who are not in low-income schools. (d) Among children, ninety percent of dental decay is in the pits and fissures of posterior permanent teeth. (e) Children who have received dental sealants in a school-based program have, for a period of up to five years, sixty percent fewer new decayed pit and fissure surfaces in their posterior permanent teeth than children who have not received an application of dental sealants. (f) Fluoride is nature's cavity fighter. Fluoride occurs naturally in almost all water sources. Since 1948, scientific research has shown that community water fluoridation can reduce the incidence of dental cavities. (g) Community water fluoridation is the process of adjusting the level of fluoride found naturally in water to a level recommended to protect against dental decay. The centers for disease control named community water fluoridation as one of ten great public health achievements of the twentieth century. (h) Water fluoridation is safe and provides the most cost-effective means to prevent tooth decay for persons of all ages and socioeconomic backgrounds. (i) Water fluoridation is one of the most researched and cost-effective oral health interventions available, as the average cost of one dental filling can fund a lifetime of fluoridation, which is known to prevent eighteen to forty percent of cavities in both children and adults. (2) The general assembly further finds that improving access to oral health care services and fluoridated water for all Coloradans, particularly low-income Coloradans, will reduce the burden of oral disease. Therefore, the Colorado oral health program dedicates itself to improving access to oral health care services by working with community stakeholders, professional organizations, and direct recipients of oral health care to remove barriers to access to oral health care. (3) The purpose of this article is to promote the public health and welfare of Coloradans by providing a grant program to: (a) Provide oral health services, including sealants, to school children; and (b) Assist communities in attaining optimal levels of fluoride in drinking water provided by community water systems as a means of preventing dental decay.”
• Regulation
  Co. Admin. Code, title 5 § 1002-11:11.19 Inorganic Chemicals Rule; Co. Admin. Code, title 5 § 1003-2:100.42 Statement of Basis, Specific Statutory Authority and Purpose

+/- Connecticut

• Statute
  Conn. Gen. Stat. Ann. § 19a-38 Water company to add fluoride to water supply
  “A water company, as defined in section 25-32a, shall add a measured amount of fluoride to the water supply of any water system that it owns and operates and that serves twenty thousand or more persons so as to maintain an average monthly fluoride content that is not more or less than 0.15 of a milligram per liter different than the United States Department of Health and Human Services' most recent recommendation for optimal fluoride levels in drinking water to prevent tooth decay.” Conn. Gen. Stat. Ann. § 19a-38.
• Regulation
  Regs. Conn. State Agencies Sec. 19-13-B102 Standards for quality of public drinking water

+/- Delaware

• Statute
  Del. Code Ann. tit. 16, § 124 Fluoridation of a water supply
  “(a) In order to protect the dental health of all citizens, especially children, the Department of Health and Social Services shall promulgate rules to provide for the addition of fluoride to all municipal water supplies by the owners or official custodians thereof. Such rules shall provide for the addition of fluoride to the water supplies so as to maintain a fluoride content of not less than that currently specified by the Department's regulations. (1) By November 15, 1998, each municipal water system shall provide to the Department an estimate of the total capital costs to install the required fluoridation treatment and additional operating costs for the ongoing operation for fluoridation treatment. (2) Subsection (b) of this section shall not apply to those municipalities which are required to comply with the mandates of subsection (a) of this section. (b) The Division of Public Health shall not require any water supply to be fluoridated which has not been fluoridated before March 26, 1974, until approval of such fluoridation is first obtained in the following manner by the users of such water supply: (1) When the Division determines that it is in the best interest of the users of a given water supply that such supply shall be fluoridated, it shall notify the administrator, owner or person who controls the water supply and the local government which it serves. Within 60 days from the receipt of such notice, the governing body of the majority of people involved shall conduct a referendum among the people served by the water supply to determine whether or not such fluoridation shall take place. Prior to any such referendum the Division shall conduct an educational program in the community affected on the fluoridation process. The costs of the referendum shall be borne by the said governing body. (2) Notice of the referendum shall be by the publication of a formal notice embodying the notice received from the Division. Such notice shall be published at least 3 times in a newspaper of general circulation in the area served by the water supply, the last publication to be at least 3 days before the referendum. Such notice shall also include the time and place of voting for the various voting districts involved. (3) Eligible voters at such referendum shall be any natural person who uses the water supply daily and who is 18 years of age or older. Each such person shall be entitled to 1 vote. (4) If the area serviced by the water supply has an established local government such government shall conduct the referendum. If 2 or more towns or municipalities are served by the water supply, the referendum shall be conducted simultaneously in each town or municipality by the governing body of that town or municipality. If the governing body is a county and not a town or municipality, the county shall be responsible for all costs of the referendum. The Department of Elections shall conduct the referendum. The referendum shall be by secret ballot and the choice for each voter shall be “For Fluoridation” and “Against Fluoridation.” The water supply shall not be fluoridated if the majority of the ballots cast are against fluoridation. (5) After a referendum is held, the matter shall be deemed to have been conclusively decided for a period of 3 years from the date of the referendum. (6) This section shall apply to any municipality within this State that has held a referendum on the question of fluoridation within the last 3 years commencing from March 26, 1974. Those municipalities that have voted not to fluoridate shall not be required to do so, except as provided by this section.”
• Regulation
  Del. Admin. Code, tit. 16, § 4462-9.0. Inorganic and Organic Chemical Requirements; Del. Admin. Code, tit. 16, § 4462-6.0 Consumer Confidence Reports

+/- Florida

• Statute
  None
• Regulation
  Fla. Admin. Code r. § 62-555.325 Fluoridation

+/- Georgia

• Statute
  None
  N/A
• Regulation
  Ga. Comp. R. & Regs. § 391-3-5-.16 Fluoridation; Ga. Comp. R. & Regs. § 391-3-5-.14 Operation; Ga. Comp. R. & Regs. § 511-5-2-.01 Fluoridation; Ga. Comp. R. & Regs. § 391-3-5-.18 Primary Maximum Contaminant Levels for Drinking Water; Ga. Comp. R. & Regs. § 391-3-21-.03 Drinking Water Fluoridation Grant Program

+/- Guam

• Statute
  None
• Regulation
  22 Guam R. & Regs. § 6126 Variance From the Maximum Contaminant Level for Fluoride; 22 Guam R. & Regs. § 6119 Public Notification

+/- Hawaii

• Statute
  None
• Regulation
  Haw. Admin. Rules § 11-20-18 Public notice requirements; Haw. Admin. Rules § 11-25-2.50 Public water system operation and management

+/- Idaho

• Statute
  None
• Regulation
  Id. Admin. Code § 58.01.08.552 Operating Criteria for Public Water Systems

+/- Illinois

• Statute
  415 Ill. Comp. Stat. 40/7a Fluoridation of water
  “§ 7a. In order to protect the dental health of all citizens, especially children, the owners or official custodians of public water supplies shall be in compliance with the recommendations on optimal fluoridation for community water levels as proposed and adopted by the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention and the rules and regulations adopted by the Illinois Environmental Protection Agency and the Pollution Control Board.”
• Regulation
  35 Ill. Adm. Code § 611.125 Fluoridation Requirement; 35 Ill. Adm. Code § 653.701 Fluoridation – Engineering Design Criteria; 35 Ill. Adm. Code § 653.702 Fluoridation Treatment Equipment Start-up; 35 Ill. Adm. Code § 653.703 Fluoride Sampling

+/- Indiana

• Statute
  IC § 36-9-2-14 Waterworks
  “Sec. 14. A unit may regulate the furnishing of water to the public. A unit also may establish, maintain, and operate waterworks.”
• Regulation
  None

+/- Iowa

• Statute
  None
• Regulation
  Iowa Admin. Code § 567-42.1(455B) Public notification

+/- Kansas

• Statute
  K.S.A. § 19-3521a Chlorination and fluoridation of water supply of district, when; notice; election provisions; fluoridation standards; K.S.A. § 65-171m Public water supply systems; primary drinking water standards; rules and regulations, authority to adopt, scope; stringency of standards; requiring fluorides prohibited
  “The governing body of any water district created and operating under the provisions of K.S.A. 19-3501 to 19-3521, and amendments thereto, may provide for the chlorination and fluoridation of the public water supply of such water district and such other processing of the public water supply in said district as the board may determine to be advisable for the purpose of improving the public water supply, except that before such public water supply shall be fluoridated: (a) The board shall publish a notice once each week for three (3) consecutive weeks in a newspaper of general circulation in the water district stating its intent to fluoridate such water supply and, if within ten (10) days after the last publication of such notice, a petition opposing the fluoridation of said water supply, signed by a number of qualified registered electors of the water district at least equal to five percent (5%) of the total number of votes cast in said water district at the last preceding general election for the office of secretary of state, is filed with the water district board of the water district, then the board shall not fluoridate said water supply unless and until the proposition to fluoridate said water supply is submitted to a vote of the electors of the district at a regular election of members of the board of the water district and a majority of those voting on the proposition shall have voted in favor thereof; or (b) the board may, if it so determines and publishes a notice of such determination as provided under (a) herein, submit the proposition to fluoridate said water to a vote of the electors of the district at a regular election of members of the board of the water district; or (c) upon a petition proposing the fluoridation of said water supply signed by a number of registered legal electors of the water district at least equal to five percent (5%) of the total number of votes cast in said water district at the last preceding general election for the office of secretary of state being filed with the water district board requesting that the proposition to fluoridate said water be submitted to a vote, the board shall publish a notice of the filing of such petition as provided under (a) herein and shall so submit the proposition to fluoridate said water to a vote of the electors of the district at a regular election of members of the board of the water district; and (d) the board shall be bound by the vote of the majority of those voting on the proposition at any election as herein provided. Such election shall be governed by the provisions of K.S.A. 19-3507 insofar as the same can be made applicable and the proposition shall be stated on the ballot in the following form: “Shall the governing body of water district No. ____ of ____ county fluoridate the public water supply of said water district?” Yes Empty Checkbox No Empty Checkbox If the board shall fluoridate the public water supply of said district it shall be in accordance with the recommendations and standards of the secretary of health and environment.” K.S.A. § 19-3521a. “The secretary of health and environment shall adopt rules and regulations for the implementation of this act.1 In addition to procedural rules and regulations, the secretary may adopt rules and regulations providing for but not limited to: (a) Primary drinking water standards applicable to all public water supply systems in the state. The primary drinking water standards may (1) identify contaminants which may have an adverse effect on the health of persons; (2) specify for each contaminant either a maximum contaminant level that is acceptable in water for human consumption, if it is economically and technologically feasible to ascertain the level of such contaminant in water in public water supply systems; or the treatment techniques or methods which lead to a reduction of the level of the contaminant sufficient to protect the public health, if it is not economically or technologically feasible to ascertain the level of the contaminant in the water in the public water supply system; and (b) establish the requirements for adequate monitoring, maintenance of records and submission of reports, sampling and analysis of water, citing criteria and review and inspections to insure compliance with the contaminant levels or methods of treatment and to insure proper operation and maintenance of the public water supply system; and (c) the definition of different categories of public water supply systems such as community water supply systems and noncommunity water supply systems and may provide for varying requirements for monitoring, maintenance of records and reporting, sampling and analysis of water, citing criteria, and review and inspections based on numbers of persons served, source of supply whether surface or groundwater or other conditions as the secretary may determine to be in the interest of public health and welfare and economic benefits. The standards established under this section shall be at least as stringent as the national primary drinking water regulations adopted under public law 93-523. No primary drinking water standard or rule and regulation may require the addition of fluorides to public water supplies.” K.S.A. § 65-171m.
• Regulation
  None

+/- Kentucky

• Statute
  KRS § 211.190 Public health services to be provided by the cabinet
  “The cabinet shall provide public health services including: (1) Administrative, consultative, technical, professional, and other services needed to assist local health departments in the effective maintenance and operation of their departments; (2) Administrative, investigative, and clerical services required by the secretary of the Cabinet for Health and Family Services, and may upon request provide these services to any other agency of this Commonwealth authorized to control the practice of any other healing art; (3) Administration of grants, gifts, or contributions from the federal government, or from other sources, for the purpose of carrying out the provisions of Pub. L. No. 725 (79th Congress, 2nd Session, chapter 958), or any other acts for the same or similar purposes; (4) Central registrations of births, deaths, and other vital records and the furnishing of copies thereof to the general public in the manner prescribed by law; (5) Statistical services, including the compilation, analysis, and maintenance of statistics on matters related to public health, and may provide these services to organizations and persons interested in public health; (6) Education of the public concerning all matters relating to health, including the publication and dissemination of health information, and the stimulation of citizen support for the promotion and maintenance of high standards of public health throughout the Commonwealth; (7) Survey and study of the needs of medical and hospital facilities in the interest of the health of the general public; (8) Establishment, maintenance, and operation of public health laboratories and such branches thereof as may be needed; (9) Establishment, maintenance, and operation of training facilities and schools for employees of the cabinet and of local health departments; (10) Tabulating, duplicating, and other ancillary services as are necessary to the operation of the cabinet, including the keeping of adequate financial, personnel, and other records; and (11) Establishment, maintenance, monitoring, and enforcement of water fluoridation programs for the protection of dental health.” KRS § 211.190.
• Regulation
  902 Ky. Admin. Regs. § 115:010 Water fluoridation for the protection of dental health

+/- Louisiana

• Statute
  None
• Regulation
  None

+/- Maine

• Statute
  M.R.S.A. § 2651-B Fluoridation; M.R.S.A. § 2653 Authorization of fluoridation; general provisions
  “No public water system may add any fluoride to its water supply without written approval of the department.” M.R.S.A. § 2651-B. “1. Requirement for authorization. No public water system may add any fluoride to any water supply without first having been authorized to do so by the affected single or multiple community water district served by it. Any public water system duly authorized to add fluoride to any water supply shall do so within 9 months after being notified in accordance with this section. The municipal clerk shall, within 10 days after the vote, notify the public water system of the vote favoring or not favoring the addition of fluoride to the public water supply. 2. Form of question. Any time the issue of whether to fluoridate a public water supply is submitted to voters, the question shall be phrased as follows: “Shall fluoride be added to the public water supply for the intended purpose of reducing tooth decay?” 3. Prohibition. Whenever a single community water district has approved fluoridation, it may not again vote on the matter for a minimum period of 2 years from the date of installation of fluoride. Whenever a single community water district has disapproved fluoride, it may not vote again on the matter for a minimum period of 2 years. Whenever a multiple community water district has approved fluoridation, it may not vote again on the matter until the first general election after 2 years from the date of installation of fluoride. Whenever a multiple community water district disapproves fluoride, it may not vote again on the matter until the next general election. 4. Authorization not required. The authorization required by subsection 1 shall not apply to any public water supply which receives or purchases less than 50% of its total annual water supply from another public water supply authorized to add fluoride to its water supply.” M.R.S.A. § 2653.
• Regulation
  ME Admin. Code 10-144Ch. 231 § 4 Operation, Maintenance and Disinfection

+/- Maryland

• Statute
  None
• Regulation
  None

+/- Massachusetts

• Statute
  M.G.L.A. 111 § 5G Water supply; treatment facilities; M.G.L.A. 111 § 8C Fluoridation of public water supplies by local boards; advice of commissioner; election; discontinuance
  “The department may require by order a city, town, person or district maintaining a water supply to provide and operate such treatment facilities as are in its opinion necessary to insure the delivery of a safe water supply to all consumers. The supreme judicial or the superior court shall have jurisdiction in equity to enforce any such order.” M.G.L.A. 111 § 5G “The department in taking cognizance of the dental health of the people in the commonwealth shall recommend such methods as in its opinion are advisable to reduce or limit the prevalence of dental caries and other dental diseases and defects. If the commissioner determines that the fluoride content of the public water supply for domestic use in any city, town or district is not at optimum level for sound dental health, he shall so notify the local board of health of his findings. Such board of health, after making such inquiry and other use of the consulting services of the department or elsewhere as it chooses, shall, if it considers doing so in the best interest of the inhabitants of the city, town or district within its jurisdiction, order the upward adjustment of the fluoride content of the water supply available for domestic use in that city, town or district. No such order shall be effective until ninety days after it has been published in a newspaper having a general circulation in such city or town, or until favorable vote has been taken in accordance with the provisions of this section, whichever occurs later. The provisions of this section shall not apply if two or more cities or towns are supplied water from the same source, if such supply to each city or town cannot be treated independently and if the majority of the boards of health representing such cities and towns have voted not to accept such recommendation; provided, however, that any such city or town desiring to adjust upward the fluoride content of the water consumed within its own jurisdiction may comply with the order by the installation of proper equipment that will comply therewith if it does not interfere with the water supply of said other cities or towns. In any city, town or district where the board of health has ordered the upward adjustment of the fluoride content of the water supply under the provisions of this section, upon petition of ten per cent of the registered voters of said city, town or district, filed in the office of the city or town clerk, as the case may be, within ninety days of the publication of such order, the following question shall be placed upon the official ballot to be used at the next regular city election or for the election of town officers at the next annual town meeting or at a biennial state election, whichever occurs first, but not earlier than sixty days following the date of filing the petition with the city or town clerk:--“Shall the public water supply for domestic use in (this city) (this town) be fluoridated?”, or in such district the following question shall be placed before the next annual meeting of the inhabitants of the district:--“Shall the public water supply for domestic use in this district be fluoridated?” If the majority of votes in answer to said question is in the negative, the water supply of such city, town or district shall not be fluoridated, and the fluoridation of such water supply shall not be ordered again by the board of health for a period of at least two years from the date of such vote.” M.G.L.A. 111 § 8C.
• Regulation
  None

+/- Michigan

• Statute
  M.C.L.A. 333.12721
  “Sec. 12721. (1) A state department, board, commission, or agency shall not order a county, city, township, village, or any combination thereof to add fluoride to water which is supplied to the public that may be consumed by human beings. (2) A county, city, township, village or any combination thereof which supplies water to the public may add fluoride to the water, in a manner and amount to be prescribed by the department, unless the addition of fluoride is rejected by an ordinance of the or by a majority of the electors of the county, city, township, village or any combination thereof.” M.C.L.A. 333.12721
• Regulation
  None

+/- Minnesota

• Statute
  M.S.A. § 144.145 Fluoridation of municipal water supplies
  “For the purpose of promoting public health through prevention of tooth decay, the person, firm, corporation, or municipality having jurisdiction over a municipal water supply, whether publicly or privately owned or operated, shall control the quantities of fluoride in the water so as to maintain a fluoride content prescribed by the state commissioner of health. In the manner provided by law, the state commissioner of health shall promulgate rules relating to the fluoridation of public water supplies which shall include, but not be limited to the following: (1) the means by which fluoride is controlled; (2) the methods of testing the fluoride content; and (3) the records to be kept relating to fluoridation. The state commissioner of health shall enforce the provisions of this section. In so doing the commissioner shall require the fluoridation of water in all municipal water supplies on or before January 1, 1970. The state commissioner of health shall not require the fluoridation of water in any municipal water supply where such water supply in the state of nature contains sufficient fluorides to conform with the rules of such commissioner.”
• Regulation
  Minn. Admin Code, part 4720.0030 Fluoridation

+/- Mississippi

• Statute
  None
• Regulation
  Miss. Admin. Code 15-20-72:3.1 General Provisions; Miss. Admin. Code 15-20-72:3.2 Adjusted Fluoridated Water System Requirements; Miss. Admin. Code 15-20-72:3.3 Optimal Fluoridation Requirements

+/- Missiouri

• Statute
  V.A.M.S. 640.135 Fluoride rules prohibited; V.A.M.S. 640.136 Modifications to fluoridation of water supply, notification required
  “The department of natural resources shall not promulgate any rule or regulation to require or prohibit the addition of fluoride to drinking water.” V.A.M.S. 640.135. “1. Any public water system, as defined in section 640.102, or public water supply district, as defined in chapter 247, which intends to make modifications to fluoridation of its water supply shall notify the department of natural resources, the department of health and senior services, and its customers of its intentions at least ninety days prior to any vote on the matter. The public water system or public water supply district shall notify its customers via radio, television, newspaper, regular mail, electronic means, or any combination of notification methods to most effectively notify customers at least ninety days prior to any meeting at which the vote will occur. Any public water system or public water supply district that violates the notification requirements of this section shall return the fluoridation of its water supply to its previous level until proper notification is provided under the provisions of this section. 2. In the case of an investor-owned water system, the entity calling for the discussion of modifications to fluoridation shall be responsible for the provisions of this section.” V.A.M.S. 640.136.
• Regulation
  None

+/- Montana

• Statute
  None
• Regulation
  Mont. Admin. R. 17.38.230 Fluoridation

+/- Nebraska

• Statute
  Neb .Rev. St. § 71-3305 Political subdivision; fluoride added to water supply; exception; ordinance to prohibit addition of fluoride; ballot; vote; Neb.Rev.St. § 71-3306 Other entity; fluoride added to water supply; rules and regulations
  “(1) Except as otherwise provided in subsection (2) or (3) of this section, any city or village having a population of one thousand or more inhabitants as determined by the most recent federal decennial census or the most recent revised certified count by the United States Bureau of the Census shall add fluoride to the water supply for human consumption for such city or village as provided in the rules and regulations of the Department of Health and Human Services unless such water supply has sufficient amounts of naturally occurring fluoride as provided in such rules and regulations. (2) Subsection (1) of this section does not apply if the voters of the city or village adopted an ordinance, after April 18, 2008, but before June 1, 2010, to prohibit the addition of fluoride to such water supply. (3) If any city or village reaches a population of one thousand or more inhabitants as determined by the most recent federal decennial census or the most recent revised certified count by the United States Bureau of the Census after June 1, 2010, and is required to add fluoride to its water supply under subsection (1) of this section, the city or village may adopt an ordinance to prohibit the addition of fluoride to such water supply. The ordinance may be placed on the ballot by a majority vote of the governing body of the city or village or by initiative pursuant to sections 18-2501 to 18-2538. Such proposed ordinance shall be voted upon at the next statewide general election after the population of the city or village reaches one thousand or more inhabitants as determined by the most recent federal decennial census or the most recent revised certified count by the United States Bureau of the Census. (4) Any rural water district organized under sections 46-1001 to 46-1020 that supplies water for human consumption to any city or village which is required to add fluoride to such water supply under this section shall not be responsible for any costs, equipment, testing, or maintenance related to such fluoridation unless such district has agreed with the city or village to assume such responsibilities.” Neb .Rev. St. § 71-3305. “Any public or private entity not included in section 71-3305 which provides a water supply for human consumption and which is not required to add fluoride to such water supply may add fluoride to such water supply in the amount and manner prescribed by the rules and regulations of the Department of Health and Human Services.” Neb.Rev.St. § 71-3306.
• Regulation
  Neb. Admin. R. & Regs. Tit. 179, Ch. 1, § 003 Operation; Neb. Admin. R. & Regs. Tit. 179, Ch. 1, § 002 Application for Certification; Neb. Admin. R. & Regs. Tit. 179, Ch. 1, § 001 Certification

+/- Nevada

• Statute
  N.R.S. 445A.015 Furnishing impure water for public use unlawful; concentration of fluoride in water; N.R.S. 445A.025 Proposal to adjust concentration of fluoride in water: Receipt by governing body of county, city or town; notice to county clerk; N.R.S. 445A.045 Adjustment of concentration of fluoride in water by supplier of water if proposal approved by voters; N.R.S. 445A.055 Regulation of fluoridation in county whose population is 700,000 or more; financial support for enforcement; payment of initial costs for compliance
  “Every owner, agent, manager, operator or other person having charge of any waterworks furnishing water for public use who shall: 1. Knowingly permit any act or omit any duty or precaution by reason whereof the purity or healthfulness of the water supplied shall become impaired is guilty of a gross misdemeanor. 2. Fail to adjust the naturally occurring fluoride concentration of the water to levels recommended by public health authorities when there has been approval by a majority of the votes cast pursuant to NRS 445A.045, or who shall adjust such concentration if such approval has not been obtained, is guilty of a misdemeanor. The provisions of this subsection do not apply to purveyors of bottled water who label their containers to inform the purchaser that the naturally occurring fluoride concentration of the water has been adjusted to recommended levels.” N.R.S. 445A.015. “Whenever the governing body of any city or town or the board of county commissioners receives a written proposal from a supplier of water, public health authorities or from any person or persons that the naturally occurring fluoride concentration of the water be adjusted to levels recommended by public health authorities, such governing body or board may, in its discretion, give notice of such proposal and the geographical area in which the water is distributed to the county clerk of each county in which any water so affected is distributed.” N.R.S. 445A.025. “The supplier may proceed to put the proposal into effect only if a majority of all the votes cast upon the question were cast for the proposal.” N.R.S. 445A.045. “1. The State Board of Health shall adopt regulations requiring the fluoridation of all water delivered for human consumption in a county whose population is 700,000 or more by a: (a) Public water system that serves a population of 100,000 or more; or (b) Water authority. 2. The regulations must include, without limitation: (a) The minimum and maximum permissible concentrations of fluoride to be maintained by such a public water system or a water authority, except that: (1) The minimum permissible concentration of fluoride must not be less than 0.7 parts per million; and (2) The maximum permissible concentration of fluoride must not exceed 1.2 parts per million; (b) The requirements and procedures for maintaining proper concentrations of fluoride, including any necessary equipment, testing, recordkeeping and reporting; (c) Requirements for the addition of fluoride to the water if the natural concentration of fluorides is lower than the minimum permissible concentration established pursuant to paragraph (a); and (d) Criteria pursuant to which the State Board of Health may exempt a public water system or water authority from the requirement of fluoridation upon the request of the public water system or water authority. 3. The State Board of Health shall not require the fluoridation of: (a) The wells of a public water system or water authority if: (1) The groundwater production of the public water system or water authority is less than 15 percent of the total average annual water production of the system or authority for the years in which drought conditions are not prevalent; and (2) The wells are part of a combined regional and local system for the distribution of water that is served by a fluoridated source. (b) A public water system or water authority: (1) During an emergency or period of routine maintenance, if the wells of the system or authority are exempt from fluoridation pursuant to paragraph (a) and the supplier of water determines that it is necessary to change the production of the system or authority from surface water to groundwater because of an emergency or for purposes of routine maintenance; or (2) If the natural water supply of the system or authority contains fluoride in a concentration that is at least equal to the minimum permissible concentration established pursuant to paragraph (a) of subsection 2. 4. The State Board of Health may make an exception to the minimum permissible concentration of fluoride to be maintained in a public water system or water authority based on: (a) The climate of the regulated area; (b) The amount of processed water purchased by the residents of the regulated area; and (c) Any other factor that influences the amount of public water that is consumed by the residents of the regulated area. 5. The Division shall make reasonable efforts to secure any available sources of financial support, including, without limitation, grants from the Federal Government, for the enforcement of the standards established pursuant to this section and any related capital improvements. 6. A public water system or water authority may submit to the Division a claim for payment of the initial costs of the public water system or water authority to begin complying with the provisions of this section regardless of whether the public water system or water authority is required to comply with those provisions. The Administrator of the Division may approve such claims to the extent of legislative appropriations and any other money available for that purpose. Approved claims must be paid as other claims against the State are paid. The ongoing operational expenses of a public water system or water authority in complying with the provisions of this section are not compensable pursuant to this subsection. 7. As used in this section: (a) “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services. (b) “Supplier of water” has the meaning ascribed to it in NRS 445A.845. (c) “Water authority” has the meaning ascribed to it in NRS 377B.040.” N.R.S. 445A.055.
• Regulation
  NV Admin. Code 445A.6682 “Fluoridation” defined; NV Admin. Code 445A.65975

+/- New Hampshire

• Statute
  N.H. Rev. Stat. § 31:17-a Referendum & N.H. Rev. Stat. § 44:15 Public Water Supplies; N.H. Rev. Stat. § 485:14-b Fluoride Statement Required
  “Upon the written application of 10 percent of the registered voters in a town, presented to the selectmen or one of them at least 15 days before the day prescribed for an annual town meeting, the selectmen shall insert in their warrant for such meeting an article relative to the use of fluoride in the public water system for said town. If the town has an official ballot, the town clerk shall insert on such ballot the following question: “Shall fluoride be used in the public water system?” Beside this question shall be printed the word “yes” and the word “no” with the proper boxes for the voter to indicate his or her choice. If a majority of those voting in a water system that serves one municipality does not approve the use of fluoride in the public water system, no fluoride shall be introduced into the public water system for said town; or if fluoride has prior to said vote, been introduced, such use shall be discontinued until such time as the majority of those voting in the town approve the use of fluoride. After such popular referendum, the selectmen shall not insert an article relative to the use of fluoride in the public water system in the warrant nor shall such question be inserted on the official ballot for a minimum period of 3 years from the date of the last popular referendum and only upon written application at that time of not less than 10 percent of the registered voters of said town. The procedure for a referendum on the use of fluoride in a town that is part of public water system serving more than one municipality shall be the procedure in RSA 485:14-a.” N.H. Rev. Stat. § 31:17-a & N.H. Rev. Stat. § 44:15. “I. If a public water supply is fluoridated, the following notice shall be posted in the water system's consumer confidence report: “Your public water supply is fluoridated. According to the Centers for Disease Control and Prevention, if your child under the age of 6 months is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance of dental fluorosis. Consult your child's health care provider for more information.” II. The notice shall be located in the section of the consumer confidence report dedicated to water quality.” N.H. Rev. Stat. § 485:14-b.
• Regulation
  N.H. Code Admin. R. Env-Dw 806.11 Fluoride SMCL; N.H. Code Admin. R. Env-Dw 811.16 Env- Additional Information for Fluoridated Public Water Supplies

+/- New Jersey

• Statute
  N.J.S.A. 24:12-2 Prohibited adulterations; drinks containing water treated with fluorides;
  “No person shall distribute or sell, or manufacture for distribution or sale, or have in his possession with intent to distribute or sell, any nonalcoholic drink, except beverages purported to be for special dietary uses, which contains glucin, saccharin, sodium cyclamate, calcium cyclamate or other nonnutritive sweeteners. The provisions of this section shall not prohibit the manufacture of, or the sale, distribution or possession of, nonalcoholic drinks which contain water obtained from a public water supply, treated with fluorides in a manner approved by the State Department of Health.”
• Regulation
  N.J.A.C. 7:10–11.15 Miscellaneous treatment processes

+/- New Mexico

• Statute
  None
• Regulation
  None

+/- New York

• Statute
  NY Public Health § 1100-a
  “1. Notwithstanding any contrary provision of law, rule, regulation or code, any county, city, town or village that owns both its public water system and the water supply for such system may by local law provide whether a fluoride compound shall be added to such public water supply. 2. Any county, wherein a public authority owns both its public water system and the water supply for such system, may by local law provide whether a fluoride compound shall be added to such public water supply. 3. No county, city, town or village, including a county wherein a public authority owns both its public water system and the water supply for such system, that fluoridates a public water supply or causes a public water supply to be fluoridated, shall discontinue the addition of a fluoride compound to such public water supply unless it has first complied with the following requirements: (a) issue a notice to the public of the preliminary determination to discontinue fluoridation for comment, which shall include the justification for the proposed discontinuance, alternatives to fluoridation available, and a summary of consultations with health professionals and the department concerning the proposed discontinuance. Such notice may, but is not required to, include publication in local newspapers. “Consultations with health professionals” may include formal studies by hired professionals, informal consultations with local public health officials or other health professionals, or other consultations, provided that the nature of such consultations and the identity of such professionals shall be identified in the public notice. “Alternatives to fluoridation” may include formal alternatives provided by or at the expense of the county, city, town or village, or other alternatives available to the public. Any public comments received in response to such notice shall be addressed by the county, city, town or village in the ordinary course of business; and (b) provide the department at least ninety days prior written notice of the intent to discontinue and submit a plan for discontinuance that includes but is not limited to the notice that will be provided to the public, consistent with paragraph (a) of this subdivision, of the determination to discontinue fluoridation of the water supply, including the date of such discontinuance and alternatives to fluoridation, if any, that will be made available in the community, and that includes information as may be required under the Sanitary Code. 4. The commissioner is hereby authorized, within amounts appropriated therefor, to make grants to counties, cities, towns or villages that own their public water system and the water supply for such system, including a county wherein a public authority owns both its public water system and the water supply for such system, for the purpose of providing assistance towards the costs of installation, including but not limited to technical and administrative costs associated with planning, design and construction, and start-up of fluoridation systems, and replacing, repairing or upgrading of fluoridation equipment for such public water systems. Grant funding shall not be available for assistance towards the costs and expenses of operation of the fluoridation system, as determined by the department. The grant applications shall include such information as required by the commissioner. In making the grant awards, the commissioner shall consider the demonstrated need for installation of new fluoridation equipment or replacing, repairing or upgrading of existing fluoridation equipment, and such other criteria as determined by the commissioner. Grant awards shall be made on a competitive basis and be subject to such conditions as may be determined by the commissioner.”
• Regulation
  NY Code of Rules and Regulations Title 10, Section 5-1.24 Approval of fluoridation of public water systems

+/- North Carolina

• Statute
  None
• Regulation
  15A NC Admin. Code 18C.1406 Control of Treatment Process; 15A NC Admin. Code 18C.1401 Policy; 15A NC Admin. Code 18C.1402 Formal Application; 15A NC Admin. Code 18C.1407 Approval May Be Rescinded

+/- North Dakota

• Statute
  None
• Regulation
  None

+/- Ohio

• Statute
  OH R.C. § 6109.20 Addition of fluoride to public water systems
  “If the natural fluoride content of supplied water of a public water system is less than eight-tenths milligrams per liter of water, fluoride shall be added to such water to maintain fluoride1 content of not less than eight-tenths milligrams per liter of water nor more than one and three-tenths milligrams per liter of water beginning: (A) On or before January 1, 1971, for a public water system supplying water to twenty thousand or more persons; (B) On or before January 1, 1972, for a public water system supplying water to five thousand or more persons, but less than twenty thousand persons.”
• Regulation
  OH Admin. Code 3745-82-04 Monitoring for compliance with the fluoride secondary maximum contaminant level

+/- Oklahoma

• Statute
  None
• Regulation
  None

+/- Oregon

• Statute
  None
• Regulation
  OR Admin. Regs. 333-061-0085 Supplemental Fluoridation

+/- Pennsylvania

• Statute
  None
• Regulation
  25 Pa. Code 25 § 109.202 State MCLs, MRDLs and treatment technique requirements

+/- Rhode Island

• Statute
  None
• Regulation
  None

+/- South Carolina

• Statute
  None
• Regulation
  None

+/- South Dakota

• Statute
  SDCL § 34-24A-1 Duty of control of fluoride content in municipal water supply; SDCL § 34-24A-3 Enforcement of fluoridation requirements--Number of users requiring fluoridation--Exemption from fluoridation requirement; SDCL § 34-24A-2 Rules and regulations relating to fluoridation of water supplies
  “Any person, firm, limited liability company, corporation, or municipality having jurisdiction over a municipal water supply, whether publicly or privately owned or operated, shall control the quantities of fluoride in the water so as to maintain a minimum fluoride content prescribed by the South Dakota Department of Environment and Natural Resources.” SDCL § 34-24A-1. “The Department of Environment and Natural Resources shall enforce the provisions of §§ 34-24A-1 and 34-24A-2. In so doing it shall require the fluoridation of water in all municipal water supplies serving a population of five hundred or more. The department may not require the fluoridation of water in any municipal water supply where such water supply in the state of nature contains sufficient fluorides to conform with the rules of the department.” SDCL § 34-24A-3. “The Department of Environment and Natural Resources shall, in compliance with chapter 1-26, promulgate rules relating to the fluoridation of public water supplies which shall include, but not be limited to the following: (1) The means by which fluoride is controlled; (2) The methods of testing the fluoride content; and (3) The records to be kept relating to fluoridation.” SDCL § 34-24A-2.
• Regulation
  ARSD 74:04:01:02 Written approval required to implement fluoridation; ARSD 74:04:01:03 Required minimum fluoride levels; ARSD 74:04:01:05 Daily testing requirements

+/- Tennessee

• Statute
  T.C.A. § 68-221-709 Fluoride
  “(a) If the quarterly analysis of a water sample from a public water system by a certified laboratory confirms that the level of fluoride in the sample exceeds one and one-half milligrams per liter (1.5 mg/L), the public water system from which the sample was taken must: (1) Obtain laboratory analysis of water samples monthly for fluoride levels; and (2) Notify all of its customers that a water sample tested exceeded one and one-half milligrams per liter (1.5 mg/L) of fluoride in a manner established by the department. (b) Once the monthly analysis of water samples for fluoride conducted pursuant to subdivision (a)(1) confirms that the fluoride level in samples is less than one and one-half milligrams per liter (1.5 mg/L) for three (3) consecutive months, the public water system may resume quarterly laboratory analysis for fluoride.”
• Regulation
  None

+/- Texas

• Statute
  None
• Regulation
  None

+/- Utah

• Statute
  U.C.A. 1953 § § 19-4-111 Fluoride added to or removed from water--Election or shareholder vote required
  “(1) As used in this section: (a) “Corporate public water system” means a public water system that is owned by a corporation engaged in distributing water only to its shareholders. (b) “Corporation” is as defined in Section 16-4-102. (c) “Fluoride” means a chemical compound that contains the fluoride ion and is used to fluoridate drinking water, including: (i) fluorosilicic acid; (ii) sodium fluorosilicate; or (iii) sodium fluoride. (d) “Fluoride supplier” means a person who: (i) manufactures, distributes, or packages or repackages fluoride; (ii) is NSF/ANSI Standard 60 certified; (iii) has evidence of the person's NSF/ANSI Standard 60 certification displayed on the website of a certification body accredited by the International Accreditation Forum, including: (A) NSF; (B) the Underwriter Laboratory; or (C) the Water Quality Association; and (iv) provides fluoride in compliance with applicable NSF/ANSI Standard 60 certification requirements. (e) “Removal” means ceasing to add fluoride to a public water supply, the addition having been previously approved by the voters of a political subdivision. (2)(a) Except as provided in Subsection (7) or Subsection 19-4-104(1)(a)(i), public water supplies, whether state, county, municipal, or district, may not have fluoride added to or removed from the water supply without the approval of a majority of voters in an election in the area affected. (b) An election shall be held: (i) upon the filing of an initiative petition requesting the action in accordance with state law governing initiative petitions; (ii) in the case of a municipal, local district, special service district, or county water system that is functionally separate from any other water system, upon the passage of a resolution by the legislative body or local district or special service district board representing the affected voters, submitting the question to the affected voters at a municipal general election; or (iii) in a county of the first or second class, upon the passage of a resolution by the county legislative body to place an opinion question relating to all public water systems within the county, except as provided in Subsection (3), on the ballot at a general election. (3) If a majority of voters on an opinion question under Subsection (2)(b)(iii) approve the addition of fluoride to or the removal of fluoride from the public water supplies within the county, the local health departments shall require the addition of fluoride to or the removal of fluoride from all public water supplies within that county other than those systems: (a) that are functionally separate from any other public water systems in that county; and (b) where a majority of the voters served by the public water system voted against the addition or removal of fluoride on the opinion question under Subsection (2)(b)(iii). (4) Nothing contained in this section prohibits the addition of chlorine or other water purifying agents. (5) Any political subdivision that, prior to November 2, 1976, decided to and was adding fluoride to the drinking water is considered to have complied with Subsection (2). (6) In an election held pursuant to Subsection (2)(b)(i), (ii), or (iii), where a majority of the voters approve the addition of fluoride to or the removal of fluoride from the public water supplies, no election to consider adding fluoride to or removing fluoride from the public water supplies shall be held for a period of four years from the date of approval by the majority of voters beginning with elections held in November 2000. (7)(a) A supplier may not add fluoride to or remove fluoride from a corporate public water system unless the majority of the votes cast by the shareholders of the corporate public water system authorize the supplier to add or remove the fluoride. (b) If a corporate public water system's shareholders do not vote to add fluoride under Subsection (7)(a), the supplier shall annually provide notice to a person who receives water from the corporate public water system of the average amount of fluoride in the water. (c) A vote of the corporate public water system's shareholders under Subsection (7)(a) does not require a supplier of another public water system, including a public water system that provides water to the corporate public water system, to add fluoride to or remove fluoride from the public water system. (8) If a local health department requires a public water system to add fluoride to public drinking water supplies under Subsection (3), the public water system shall fluoridate the public drinking water supplies with fluoride manufactured, distributed, packaged, and, if applicable, repackaged by a fluoride supplier who has provided copies of the original, dated documents used to obtain and maintain NSF/ANSI Standard 60 certification to: (a) the local health department that oversees the public water system; and (b) the division. (9) A public water system described in Subsection (8) shall obtain, for each quantity of fluoride acquired to fluoridate public drinking water supplies, a batch-specific certificate of analysis that represents the complete composition of the formulation of the undiluted raw fluoride substance, in percent or parts by weight, for each chemical and contaminant in the batch. (10) A local health department shall: (a) order the temporary removal of fluoride from a public water system within the boundaries of the local health department if the public water system: (i) violates Subsection (8) or (9); or (ii) is unable to fluoridate public drinking water supplies in accordance with Subsections (8) and (9); and (b) review and maintain the certification documents submitted to the local health department under Subsection (8). (11) A public water system described in Subsection (8) shall: (a) review and maintain certificates of analysis obtained under Subsection (9); and (b) upon request of a member of the public, provide a copy of a certificate of analysis obtained under Subsection (9) to the member of the public. (12) A local health department may order the temporary removal of fluoride from a public water system within the boundaries of the local health department if the public water system violates a provision of Subsection (11). (13) If a local health department orders the removal of fluoride from a public water system under Subsection (10)(a) or (12), the local health department shall: (a) issue a public notice regarding the temporary removal of fluoride from the public water system; and (b) when the public water system demonstrates its ability to fluoridate in accordance with Subsections (8), (9), and (11), revoke the removal requirement. (14) The division shall review and maintain the certification documents submitted to the division under Subsection (8).” U.C.A. 1953 § 19-4-111.
• Regulation
  None

+/- Vermont

• Statute
  None
• Regulation
  Vt. Admin. Code 16-3-500:7.3 Fluoridation

+/- Virginia

• Statute
  None
• Regulation
  12 VAC 5-590-930 Fluoridation

+/- Washington

• Statute
  RCWA 57.08.012 Fluoridation of water authorized
  “A water district by a majority vote of its board of commissioners may fluoridate the water supply system of the water district. The commissioners may cause the proposition of fluoridation of the water supply to be submitted to the electors of the water district at any general election or special election to be called for the purpose of voting on the proposition. The proposition must be approved by a majority of the electors voting on the proposition to become effective.”
• Regulation
  WA Admin. Code 246-290-460 Fluoridation of drinking water

+/- West Virginia

• Statute
  None
• Regulation
  W. Va. Code St. R. § 64-3-8 § Public Water System Fluoridation

+/- Wisconsin

• Statute
  None
• Regulation
  None

+/- Wyoming

• Statute
  None
• Regulation
  None

+/- Washington, D.C.

• Statute
  None
• Regulation
  None