Name: Email:     1. Does your water leave any stains or residuals in toilets, sinks,   tubs, or shower stalls? If so what color, please select what bests describes the deposit: a. Blue-Green b. Yellow-Orange-Red c. Grey-Black d. White-Scale     2. Does your water have any odor to it? If so, which best   describes it: a. Rotten-Egg/Sulfur b. Earthly-Metallic c. Chlorine d. Other   Enter Other:     3. Is the odor stronger in the hot or cold water?   Answer:     4. Does the odor come from a single fixture or multiple fixtures?   Answer:     5. Have you ever had any pin hole leaks in your plumbing   structure or fixtures?   Answer:     6. Are you experiencing issues with dry skin?   Yes   No     7. Do the aerator screens in your sink faucets get plugged with   sediment?   Yes   No     8. Do you experience more than occasional bouts of nausea or   diarrhea?   Yes   No     Note: The above is basic water evaluation. From this information we can get an idea of what the problems are with your water. However, we strongly suggest having your water professionally tested by a state certified laboratory for biological, radiological, and chemical/mineral levels on a periodic basis. These tests will inform you of anything relative to the safety of the water. In addition some of these results can impact approaches in solving your water quality issues.     Comments: