Lead Service Line Survey

by North City Water District

We would like to ask your assistance in helping us gather critical information using the below form, as the first step in establishing our District’s Lead Service Line Inventory for the EPA.

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* 1. Your Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. What year was your home or building constructed?

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* 3. Have you, or a previous property owner, ever replaced the water service line?

Yes

Unknown

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* 4. If the water service line has been replaced, what year was it done?

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* 5. What material is your current water service line, if known?

Lead (shows shiny metal when scratched, and will NOT hold a magnet)

Galvanized (shows dull metal when scratched, and WILL hold a magnet)

Copper (shows the same copper color as a penny when scratched)

PVC / Plastic / PEX

Unknown

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