H20 Lead Awareness Survey - Consolidated Water District #1

H20 Lead Awareness
Customer Service Line
Plumbing Survey

Completed By *

First

Last

Customer Name *

First

Last

Date Completed *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Customer Service Line and Plumbing Information

Year House/Building was Built (if known) *

Customer Side Service Line Install Year *

Customer Side Service Line Material (water meter to house) *

Customer Side Service Line Size *

Building Type *

Do you have any Water Filter, Softener or Water Treatment in your home/business *

Primary Plumbing Material In Your House: *

Secondary Plumbing Material In Your House *

What Year Was Your Plumbing Installed (Range): *

Do you consent to providing a water sample for testing? *

If you are selected, a water district employee will bring a sample bottle to your home and then pick it up the next day. There is no cost to the customer.

If you need help with this survey, please call our office at 913-724-7000.

Comments

H20 Lead Awareness Customer Service Line Plumbing Survey

Directions

Customer Service Line and Plumbing Information

If you need help with this survey, please call our office at 913-724-7000.

H20 Lead Awareness
Customer Service Line
Plumbing Survey