NAME ON ACCOUNT:
*
ACCOUNT # OR ADDRESS:
*
INSPECTION
I DO NOT GIVE PERMISSION TO HAVE MY SERVICE LINE INSPECTED BY BECKLEY WATER COMPANY
YEAR THE HOUSE WAS BUILT
3. WHAT TYPE OF MATERIAL IS USED FOR YOUR SERVICE LINE (FROM THE METER TO YOUR SHUTOFF VALVE)? (CHECK ALL THAT APPLY)
*
PLASTIC (OR PEX)
GALVANIZED
COPPER
OTHER
DO NOT WANT TO REPORT
TYPE OF CUSTOMER SIDE SERVICE LINE MATERIAL
4. WHAT TYPE OF MATERIAL IS CURRENTLY BEING USED INSIDE YOUR HOME? (CHECK ALL THAT APPLY)
*
PLASTIC (OR PEX)
GALVANIZED
COPPER
OTHER
DO NOT WANT TO REPORT
CUSTOMER MATERIAL INSIDE THE HOME
TAKE PHOTO OF PLUMBING AT POINT OF ENTRY TO THE HOME (THIS CAN BE USED FOR VERIFICATION PURPOSES)
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of
TAKE PHOTO OF PLUMBING AT POINT OF ENTRY TO THE HOME (THIS CAN BE USED FOR VERIFICATION PURPOSES)
Upload a photo
Browse Files
Drag and drop files here
Choose a file
Cancel
of
SIGNATURE
*
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
NOTES/COMMENTS
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