Water Use Survey

Please provide the following information about your facility's water use so the Division of Water Resources can determine whether you should be reporting your water use annually.

Facility Name:
Company Name:
County:
Mailing Address:
City:
State:
Zip:
Contact Person:
Phone:
Email:
What source(s) of water are used at this facility? (Check all that apply)
Ground Water
Surface Water
Reclaimed Water
Purchase Water
If purchase water is used, which water system suppiles it?
What is the maximum day withdrawal for this facility?
Gallons
Do you have any comments?