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Lead Service Line Inventory Questionnaire
*
1.
Contact Information
(Required.)
Name
*
Company (if applicable)
Address
*
Address 2
City/Town
*
State/Province
*
ZIP/Postal Code
*
Phone Number
*
*
2.
Type of Property
(Required.)
Single Family
Multi-Family (Apartment, Duplex)
Commercial
Industrial
*
3.
Service Line Material
(Required.)
Lead
Copper
Galvanized Steel
Plastic (Polyethylene)
*
4.
Service Line Material Installation Date
(Required.)
*
5.
Is the Point-of-Entry a Water Softener or Whole Home Filtration System?
(Required.)
Yes
No
*
6.
Interior Plumbing Material
(Required.)
Lead
Copper
Galvanized Steel
Plastic (Polyethylene)
*
7.
Interior Plumbing Material Installation Date
(Required.)
*
8.
May the City use this Address for future Lead and Copper Sampling?
(Required.)
Yes
No
