Lead & Copper Survey

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NORTHEAST LAWRENCE UTILITY DISTRICT

1054 MATTOXTOWN RD

LAWRENCEBURG, TN 38464

(931) 762-9481

Check all that apply plumbing materials: *

Lead (dull, dark gray. Easily scratched with hard object, shiny when scratched)

Copper (copper color, green tarnish)

Known to have lead solder

Galvanized Iron/Steel (Magnetic, black-dark gray, some reddish-brown rust, hard to scratch)

PVC

Other

Your participation in this program helps protect the health of your community. Please contact us with any questions. Thank you for your assistance.

Physical Address *

What type of service line connects the home to the water meter?

Northeast Lawrence Utility District 1054 Mattoxtown Rd., Lawrenceburg, TN 38464 Phone: (931) 762-9481

Lead and Copper Plumbing Survey

Thank you for your interest in protecting your health and the health of your community. To maintain complete records and estimate your home's lead-exposure risk, we ask that you complete this survey.

All required fields are flagged with a red asterisk. Form will not submit without all these fields completed.

Year of plumbing at main consumption tap: *

Phone *

What type of plumbing materials are used within the home?

Customer Name: *

Mailing Address *

Is a permanent water filter installed in your home? *

Yes

Check all that apply service line materials: *

Lead (dull, dark gray. Easily scratched with hard object, shiny when scratched)

Copper (copper color, green tarnish)

Known to have lead solder

Galvanized Iron/Steel (Magnetic, black-dark gray, some reddish-brown rust, hard to scratch)

PVC

Other

Is a water softener installed in your home *

Yes

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