Recycled Water Program Inspection Request Form

Print
Press Enter to show all options, press Tab go to next option
Please correct the field(s) marked in red below:

EID Recycled Water Program inspection requests will be completed within two business days after the request date.

Please note:  The day of the request is not recognized as the first business day. 

Fields marked with *  are required to be completed to process the request.

Select the type of inspection below:

 *
Other - please provide details if "Other" was selected in the drop down menu above:
Contact First Name:
 *
Contact Last Name:
 *
Company/Business Name:
Contact Phone Number:
 *
Please add the address locations and lot number for each location.
Inspection Addresses: Lot Number (if known)
Location 1
Location 2
Location 3
Location 4
Location 5
Contact Email:
 *
Additional Information:
  1. To receive a copy of your submission, please fill out your email address below and submit.