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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 /> k. Total of A-J <br /> 4 <br />