Lead & Copper Questionnaire

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Please correct the field(s) marked in red below:

1
Name
2
Address
 *
3
My Home was Built after 1982 and before 1988?
 *
4
Does your home have copper pipes?
 *
5

Does your home have a water treatment device (such as a water softener or reverse osmosis system) installed?

 *
6
If your home does have a treatment device, can the device be bypassed?  
 *

Please provide a phone number and e-mail address where you can be contacted about this sampling:

 

7
Phone Number
 *
8
email address:
 *
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