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SECTION C — WATER SUPPLY <br /> 1 . Water Sources : (Check as many as are applicable) <br /> ( ) Private Well <br /> ( , ) Surface Water <br /> ( ) Municipal Water Utility (Specify City) : <br /> ( ) Other (Specify) <br /> 2 . Name on the water bill : <br /> Name : <br /> Street: <br /> City: State : Zip : <br /> 3 . Water service account number: <br /> 4 . List average water usage on premises : <br /> ( New facilities may estimate ) <br /> Type Average Water Indicate Estimated (E ) <br /> Usage (GPD ) or Measured ( M ) <br /> a . Contact cooling water <br /> b . Non-contact cooling water <br /> c. Boiler feed <br /> d . Process <br /> e . Sanitary <br /> f. Air pollution control <br /> g . Contained in product <br /> h . Plant & equipment washdown <br /> I . Irrigation & lawn watering <br /> j . Other <br />