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2. Street Address*
4. Property Owner Name (Last, First)*
6. Phone*
7. Email*
9. Year Property Built*
11. Property Class*

    1. Single Family
    2. Business / Commercial
    3. Multi-Family
    4. Other
13. Service Line Material*

    1. Lead
    2. Galvanized Steel
    3. Copper
    4. Plastic / PEX
    5. Other

15. Your service line material is either lead, galvanized steel, copper, or plastic/PEX. You can perform some tests on the private side of your service line to determine the material. One test is the scratch test. By scratching the private side of your service line with a quarter, where it comes into your home/business, you will be able to determine the material. You can also perform the magnet test by attempting to stick a magnet to the line. Read on to find out how to conduct these tests.

17. 
19. Records of Work
21. If you have any records of work on your service line, especially if the service line has ever been replaced, please indicate the work performed and the approximate date
23. Water Service Line Point of Entry*

    1. Garage
    2. Basement
    3. Crawlspace / Utility Room
    4. Other
25. From what direction does the water service line come into your property? (Ex: Service line comes into the basement on the Northwest corner of the house)
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27. 1. Receive an email copy of this form.
28. Email address

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29. Submit

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