Customer Name Account Number Email Address Type of Structure Single-Family Residential Multi-Family Residential Business Business / Residential Estimated distance from residence to curb Lead pipe before water meter Lead pipe before water meterThis question relates to the section of pipe located between the property line and your water meter. Yes No Identify materials before the meter. If know please indicate the material of the water service line coming into your home from the curb box and / or foundations. Copper / Lead Solder Copper Galvanized Lead Brass Unknown Other Specify Lead pipe after water meter Lead pipe after water meterThis question relates to the section of pipe located between your water meter and your faucets. Yes No Identify materials after the meter. If know please indicate the material of the water service line coming into your home from the curb box and / or foundations. Copper / Lead Solder Copper Galvanized Lead Brass Unknown Other Specify Does your home plumbing have any of the following? Water Filter Water Softener Other None Please specify if filters the entire house or only at the point of the use of the filter (i.e. attached to your faucet) What year was your home built? Any plumbing modifications in the past 2 years? Yes No Please Specify LOOK UP MY SERVICE LINE
