Water Use Survey

Which Best describes your facility?              
Do you have an irrigation system?                
Do you have a fire protection system?         
Do you use water from another source?       
Do you have any water equipment?              
(Other than standard plumbing fixturess,
water softners, etc?)
Do you use chemicals? (Other than               
standard household cleaners?)
Do you have backflow preventers?                
Additional Backflow preventers and/or        
notes

Name:                                                         
Position/Title:                                             
Company:                                                   
Address:                                                     
City, State and Zip:                                      
Phone Number:                                          
Email:                                                        
Site Contact:                                             
Site Name:                                                 
Site Address:                                             
Site City, State and Zip: