General Information
Element 1 - Source Issues Issues Present: Yes No N/A
Element 2 - Pumps, Pump Facilities and Control Issues Issues Present: Yes No N/A
Element 3 - Storage Issues Issues Present: Yes No N/A
Element 4 - Treatment Issues? Issues Present: Yes No N/A
Element 5 - Distribution System Issues/Cross Connections Issues Present: Yes No N/A
Description of Corrective Action (if required)*
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