Forms • Service Line Inventory

Service Line Inventory

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Name*

Address*

Account Number*

Phone Number

Email Address

1. Year Home was built

2. Has your Water Service Line been replaced since the home was built? (the service line is the water line from the curb stop that comes into your home connecting to the water meter)*

	Yes
	No

Unkown

3. Water Service Line Material*

	Lead
	Copper
	Galvanized Steel

	Plastic
	Unkown

4. Other Lead Materials known, if yes what?*

	Yes
	No

Unknown

If you marked yes on 4., what materials?

* indicates required fields.

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