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2. Service Address*
4. Which option below best describes you? *
   -- Select One --OwnerTenantProperty ManagerOther

   Please use the drop-down menu to make a selection.

6. Your Name*
7. Phone Number
9. Email Address (optional)
11. What is the structure type?
    -- Select One --ResidenceCommercialOther

    Please use the drop-down menu to make a selection. 

13. If you selected "other" structure type, please explain
15. What year were the water lines established in the structure, if known?
17. Size of line, if known

    1. 1/2 inch
    2. 3/4 inch
    3. 1-inch
    4. 1 1/4 inch

    1. 1 1/2 inch
    2. 2-inch
    3. 3-inch
    4. 4-inch
19. EXAMPLE BELOW TO HELP DETERMINE SERVICE MATERIAL

    

21. Service line material at the point of entry (inlet) to your home?*
    -- Select One --LeadCopperGalvanized SteelInaccessibleOther (plastic/PVC/pex/etc.)

    Please use the drop-down menu to make a selection. 

23. Has the line from the water meter to your home/facility been replaced?*
    -- Select One --YesNoUnknown

    Please use the drop down menu to make a selection.

25. If yes, please provide the date and material used for replacement.
27. If possible please upload a photo of the water line entering your home.

    Upload an existing image, use your camera to upload a new image, or email a picture to info@nevadamo.gov

29. Please contact the public works department if you need assistance with this request @ 417-448-5114.

    To show our appreciation for your assistance, you will receive a credit of $10.00 on your bill. The survey must be completed by September 23, 2024 to receive this credit. 

    Thank you for helping meet compliance with the EPA regulation. 

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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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