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M <br />Water Line survey Form <br />Yes, I desire hookup to the water supply offered <br />by the U.S. EPA, and will be able to attend the <br />meeting times on� 3 <br />Yes, I desire hookup to the water supply offered <br />by the U.S. EPA, but will not be able to attend <br />the meeting times on - jpr / 3 <br />No, I do not desire my residence to be included in <br />the water supply offered by the U.S. EPA. I <br />understand that by refusing this offer, if the <br />plume of contamination should spread to my home, <br />I, as the homeowner will be responsible for any <br />remediation costs. Also, I understand that any <br />filter currently provided by_ <br />fry:, will be my responsibility <br />to maintain. <br />Name: J12 <br />Address: O fa 2 3 <br />------------------------------------------------------------ <br />i <br />