Customer Owned Service Line Material Survey

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* 1. What material is the customer owned portion of your service line?

Plastic (High Density Polyethylene or PVC)

Copper

Galvanized Steel

Lead

Other (please specify)

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* 2. What material is used inside of your home for the plumbing?

Plastic (PEX, PVC. etc.)

Copper

Galvanized Steel

Other (please specify)

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* 3. What year was your residence constructed? (Estimate if the exact year is unknown.)

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* 4. What is your name?

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* 5. What is your service address?

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* 6. What is your six digit account number?

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* 7. What is your phone number?