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Drinking Water Investigation Form - Form 37
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Date identified
*
Date identified
Date identified
Location
*
Name
*
Email Address
*
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Duration of Problem
*
Frequency of Problem
Description of odor/taste
*
-- Select One --
Ammonia
Metal
Fishy
Garlic
Medical
Rotten Egg
Skunk
Chlorine/Beach
Other
If other, please explain below
Color
*
-- Select One --
Blue
Brown
Black
Yellow
Green
Cloudy
Clear
Other
If other, please explain below
Comments
Telephone: 800-826-5721
Form 37 – Rev 9/23/19
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