Lead Service Line Inventory MO Dept of Natural Resources
PWSD #2 would like to thank you for taking the time to complete this form. We would greatly appreciate it if you could submit your responses as soon as possible. Thank you!
Water Service Account Number as it appears on your bill.
*
Full name as it appears on your water service bill.
First Name
Last Name
Type of Property receiving water service at this location.
*
Please Select
Single Family
Multi-Family
School/Childcare
Business
Hospital/Medical Care Facility
Nursing Home
Other
Phone Number
*
Please enter a valid phone number.
Email
*
Preferred method of contact?
Email
Phone
Other
The year this property was built?
The year customer portion of the Service Line was installed/replaced?
Material customer portion of the Service Line is made of?
Please Select
Copper
Galvanized
Pex
Polyvinyl Chloride (PVC)
Lead
Other-Non-Lead
Unknown
Size of the Customer portion of the Service Line? (If Known)
Please Select
3/4 Inch
1 inch
1 1/2 inch
2 inch
> 2 inch
Primary material of this locations internal plumbing?
Please Select
Copper
Galvanized
PEX
Polyvinyl Chloride (PVC)
Lead
Other-Non-Lead
Unknown
Is a water softener or any type of filtration being used within the building? If so what type and where?
Please upload a photograph of the Service Line area you tested.
Browse Files
Drag and drop files here
Choose a file
This photo can be emailed to pwsd2@pwsd2.org
Cancel
of
Submit
Should be Empty: