Whirinaki and Esk Valley water survey

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1. Name (Required.)

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2. Address (Required.)

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3. Mobile

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4. Email

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5. In the last eight weeks have you had discoloured water? (Required.)

Yes

If yes, how many times?

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6. If 10 is black and 1 is clear, what number is your water on a bad day?

Clear

i We adjusted the number you entered based on the slider’s scale.

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7. If 10 is black and 1 is clear, what number is your water on a good day?

Clear

i We adjusted the number you entered based on the slider’s scale.

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8. Do you have a household water treatment system?

Yes

If yes, was the treatment system installed before or after Cyclone Gabrielle? Please list type e.g. filter, water softener etc.

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9. I’d like to sign up for SMS text alerts for advance warning of water use changes

Yes - please ensure you have entered your mobile number above.

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10. I’d like to sign up for an email database for future community updates

Yes - please ensure you have entered your email address above.

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11. Have you been receiving our letter box water updates?

Yes

Whirinaki and Esk Valley water survey

Question Title

* 1. Name (Required.)

Question Title

* 2. Address (Required.)

Question Title

* 3. Mobile

Question Title

* 4. Email

Question Title

* 5. In the last eight weeks have you had discoloured water? (Required.)

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* 6. If 10 is black and 1 is clear, what number is your water on a bad day?

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* 7. If 10 is black and 1 is clear, what number is your water on a good day?

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* 8. Do you have a household water treatment system?

Question Title

* 9. I’d like to sign up for SMS text alerts for advance warning of water use changes

Question Title

* 10. I’d like to sign up for an email database for future community updates

Question Title

* 11. Have you been receiving our letter box water updates?

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* 12. Questions or comments

1. Name (Required.)

2. Address (Required.)

3. Mobile

4. Email

5. In the last eight weeks have you had discoloured water? (Required.)

6. If 10 is black and 1 is clear, what number is your water on a bad day?

7. If 10 is black and 1 is clear, what number is your water on a good day?

8. Do you have a household water treatment system?

9. I’d like to sign up for SMS text alerts for advance warning of water use changes

10. I’d like to sign up for an email database for future community updates

11. Have you been receiving our letter box water updates?

12. Questions or comments