Lead Service Line Assessment Name(Required) First Last Address(Required) Street Address 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 Phone(Required)Email(Required) Submitted by Homeowner Renter PUC Employeehoice See below for where the scratch area should be. Picture UploadMax. file size: 10 MB. Please include a picture of the scratched area of the pipe.Service Pipe TypeCopperPlasticThird ChoiceLeadI would like to schedule an evaluation Please Contact Me Check this box if you'd like to schedule a time for Utility staff to evaluate your serviceTo ensure we have received your response. Please make sure to wait to close your browser until you see the "Thank You! Your form has been submitted" message after clicking "Submit"CAPTCHA
