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Google Homepage»Modules»Forms Library»Field Data Collection Form (Water Conservation) Form

First Name*

Last Name*

Business Name

Street Address

City

Zip Code

Title

Telephone

Email

Cell

Date of Report

Comments if Any

Is your Residential Gallons per Capita Day below 65

Yes

No

Is your Unaccounted for Water below 10

Yes

No

Do you have an Emergency Management Plan describing procedures for handling water emergencies

Yes

No

Do you have a Drought Management Plan

Yes

No

Do you conduct an annual water audit of your system

Yes

No

Do you conduct a full leak detection program for your distribution system every two years

Yes

No

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Signature*

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