Water Service Line Material Self-Reporting Form "*" indicates required fields Name* First Last Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I am the…* Property Owner Tenant Does a magnet stick to your service line?** Yes No Unsure What color is the pipe of your service line?* Copper (with or without Green/Blue) Gray or Silver Black or White Other Upload a photo of your service line*Max. file size: 49 MB.Photo must show the material of your service line after completing the scratch test. The scratched surface (on the section of pipe between where the pipe enters your property and the water meter) should be visible in your photo.What year was your property built in?* If you are unsure, make your best guess and include a comment that your answer is a guess.Comments or Concerns Δ
