WATER CUSTOMER LEAD AND COPPER RULE FORM

The city is requesting your assistance in meeting compliance with EPA regulations by completing the water customer lead and copper rule form.

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Name

Phone Number

Email Address

Service Address

What year was the structure built (if known)?

I am the

Owner

Tenant

Property Manager

Other

This is a

Residence

Business

Barn

Other

Service line material at point of entry to structure is

lead (shiney silver)

copper (orange)

steel (dull gray)

plastic

What year were the water lines within the structure established (if known)?

Has the line from the water meter to the structure been replaced (if known)?

If yes, please provide date and material used (if known).

Contact Information

102 W Clay St
Rock Port, MO 64482

Phone: 660-744-2676
Fax: 660-744-5553

Monday - Friday
9:00 a.m. - 4 :00 p.m. (closed 12-1)

Located between
City Hall & the Fire Station
on Main Street

500 S. Main Street | Rock Port, MO 64482 | 660-744-2636