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Cross Connection Control Survey

  1. If you need help completing this form, please contact Brian Longpre at or (209) 642-0749
  2. List of potential hazards on site*
  3. If you have a device installed, please complete the information below.
  4. Type of device
  5. The City of Lodi thanks you for your participation in this survey
  6. Leave This Blank:

  7. This field is not part of the form submission.