First Name: Last Name: Phone Number: Email Address: Address: City: State: Zip Code: Do you own or rent this building? OwnRent What year was this building built? To your knowledge, has the water service line for your building ever been replaced? YesNoNot Sure What material is your water service line? You may choose more than one. LeadCopperSteel (ductile iron pipe, galvanized)Plastic (HDPE, PVC)UnknownCannot locate service line How did you determine the material? Scratch testVisualPlumber or other qualified professionalCannot locate service line Please write your signature in the box below (required)

Clear