Severe Weather Impact on CA Utilities
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1.
Utility Name
(Required.)
*
2.
Person of Contact
(Required.)
*
3.
Street Address
(Required.)
*
4.
City
(Required.)
*
5.
State
(Required.)
*
6.
Zip
(Required.)
*
7.
Email
(Required.)
8.
Phone
9.
County
10.
Regulated By
11.
Number of Connections
*
12.
Water
(Required.)
Yes
No
*
13.
Wastewater
(Required.)
Yes
No
*
14.
Has your system been impacted by severe weather?
(Required.)
Yes
No
15.
If you were impacted by the 2022-2023 winter weather events please describe the nature of the impact.
16.
Have you received support from local, state, or federal agencies? If yes, please document what type of assistance you received and list which agency.
17.
Is there further assistance you would like to receive or information that we may be able to assist you with?
18.
Anything else you wish to add?
