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2. 

4. First and Last Name*
5. Email Address
7. Address*

   Please provide the address where the water quality incident is taking place. 

9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. What water quality issue are you experiencing?*
    -- Select One --Discolored waterTaste and odorSedimentWater pressure
16. If you are experiencing discolored water, how long has it been occurring at this location? (For this incident.)
17. What does the color of water resemble?

    Example: coffee, tea

19. Have you run COLD water for 5-10 minutes to clear the line?
    -- Select One --Yes No
20. After running COLD water did the discoloration return?
    -- Select One --Yes No
22. More information on discolored water
    Discolored Water Fact Sheet (PDF)
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field