Thank you for your interest in participating with the lead and copper monitoring. To maintain complete records and estimate your home's risk factor, we ask that you complete this survey.

1

Customer Name

 *

Customer Name

2

Phone Number

 *

ext.Phone Number

3

Physical Address

 *

Physical Address

4

Mailing Address

 *

Mailing Address

5

Year of Plumbing at Main Consumption Tap

 *

Year of Plumbing at Main Consumption Tap

6

Is a Permanent Water Filter Installed In Your Home?

Is a Permanent Water Filter Installed In Your Home?

Yes

No

7

Is A Water Softener Installed In Your Home?

Is A Water Softener Installed In Your Home?

Yes

No

8

What Type of Plumbing Materials Are Used Within The Home?

What Type of Plumbing Materials Are Used Within The Home?

Lead - (dull, dark grey, similar to pencil lead; easily scratched with hard object, shiny when scratched)

Copper - (copper color, green tarnish)

Galvanized Iron/Steel - (black, some reddish-brown rust, hard to scratch)

Plastic

Thank you for your assistance, 

David Hunter, Director of Public Utilities

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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