Water Service Line Inventory
Customer Response Form
Full Name
*
First Name
Last Name
Service Address
*
Street Address
Apartment/Unit/Number
City
State / Province
Postal / Zip Code
Contact Number
*
Email Address
*
example@example.com
Upon visual inspection, the service line entering the home is
*
Plastic (PVC, PECX, HDPE, hard, rigid, durable plastic can be colored)
Copper (shiny like a new penny)
Galvanized Steel (silver or gray, magnet will stick to it)
Lead (blue-gray shiny when scratched)
I am unable to identify my service line material and require additional assistance.
Please Select
Yes
No
Additional information/Comment
To the best of my knowledge the information reported on this form is accurate. Signature
*
Submit
Submit
Should be Empty: