City of Rockford Water Division

For more detailed instructions and more information on lead and drinking water visit our Lead and Drinking Water page at www.rockfordil.gov

Thank you for your help!

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* 1. The address of the property is...

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* 2. I am the...

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* 3. Who inspected the water service line at the above address (from its point of entry into the building to its connection with the water meter) in order to determine whether the water service line is lead, copper, galvanized steel, plastic or other material (How to Identify Private Water Service Line Material)?

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* 4. The service material was determined to be made of:

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* 5. I have determined from the above inspection that the property does / does not contain a lead water service line.

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* 6. Contact Information (optional and will not be distributed)

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