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Surveys
2013
June
L
Long Creek Township Water Department Residential C
Long Creek Township Water Department Residential C
Long Creek Township Water Department Residential Cross Connection Customer Survey
0%
Questions marked with an
*
are required
Exit Survey
*
Customer Name
*
Name of Person Completing Survey
*
Phone Number
*
Customer Address
Inside Residential Plumbing Fixtures, Machines, and Devices
Yes
No
Not Sure
*
Kitchen Sink Faucet Sprayer
*
Ice Maker
*
Electric Dish Washer
*
Water Purifier
*
Water Softener
*
Deep Utility Sink
*
Boiler Heat
*
Whirlpool/Hot Tub
*
Bidet
*
Toilet
*
Shower Sprayer with Hose
Other Inside Residential Plumbing Fixtures, Machines, and Devices
Outside Residential Plumbing Fixtures, Machines, and Devices
Yes
No
Not Sure
*
Outside Faucets
*
Lawn Irrigation System
*
Portable High Pressure Washer
*
Swimming Pool
*
Garden Hose Chemical Sprayer
*
Pond
*
Whirlpool/Hot Tub
*
Private Well/Cistern
*
Yard Hydrant
Other Outside Residential Plumbing Fixtures, Machines, and Devices
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