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Commercial Cross-Connection Survey

Please correct the field(s) marked in red below:

By submitting this survey you certify under penalty of law, that the following information is, to the best of your knowledge and belief, true, accurate, and complete.
1
Contact Information
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Contact Information
2

Description of Business:

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3
Does the property have an auxiliary water source, such as a private well or Reclamation District Water?
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Does the property have an auxiliary water source, such as a private well or Reclamation District Water?
4
Is the connection to the auxiliary water source protected?
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Is the connection to the auxiliary water source protected?
5
Does the property have an underground lawn sprinkler system?
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Does the property have an underground lawn sprinkler system?
6
Is the connection to the underground lawn sprinkler system protected?
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Is the connection to the underground lawn sprinkler system protected?
7
Does the property have a lawn sprinkler system using chemicals, fertilizer, or has a booster pump?
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Does the property have a lawn sprinkler system using chemicals, fertilizer, or has a booster pump?