Lead Pipe Survey Step 1 – Read and Follow Instructions on this Form: Step 2 – Complete this form and submit online: Question 1: Customer Contact Information: Account Number * Name First Last * Street Address Mailing Address Email Address * Question 2: Were you able to find your drinking water service line? Yes No * Question 3: Were you able to perform a scratch test? Yes No * Question 4: What was the color result after the scratch test? Shiny and silver – Lead Copper colored (like a penny) – Copper Dull and gray – Galvanized Visibly plastic (White and rigid) – Plastic I am not sure. * Question 5: Were you able to perform a magnet test? Yes No * Question 6: What was the result of the magnet test? The magnet does not stick to the pipe The magnet sticks to the pipe Question 7: Add a photo of the pipe tested here: Field Label Max file size is 536 MB. Question 8: Additional information here:
