City of Roundup – Leadline Form

Please read the entire form, test instructions, and examples carefully before filling out this form.

Your contact info is only required if you wish to schedule an inspection or would like City staff to contact you. If you have more than one water service line entering the building, please complete the test for each water service line.

Street Address *

What is the color of the scraped pipe on the upstream/street side of the water meter?

Does a magnet stick to the pipe? *YesNoSlightly

If you are uncertain of your water service line material, please take a photo of the exposed and scratched service line where it enters the building and return it with this form.

Is there water treatment in the building?

Was the plumbing in your building ever remodeled?

YesNo

If yes, when:

The following information is optional:

Please provide your preferred method of contact information if you would like to schedule an inspection or be contacted by the City of Roundup.

Please enter the following information:

First Name

Last Name

Street Address/P.O. Box

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Phone

Email Address

City of Roundup – Water Service Line Inventory Test Form

Please read the entire form, test instructions, and examples carefully before filling out this form.

Your contact info is only required if you wish to schedule an inspection or would like City staff to contact you. If you have more than one water service line entering the building, please complete the test for each water service line.

The following information is optional: Please provide your preferred method of contact information if you would like to schedule an inspection or be contacted by the City of Roundup.

Please enter the following information:

The following information is optional:

Please provide your preferred method of contact information if you would like to schedule an inspection or be contacted by the City of Roundup.