Request edit access
Lead and Copper Sampling
Free lead and copper testing is available for City of Columbia Utilities- Water customers. Please complete this form so we can get your address on the list.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Address *
Phone Number *
Year Home Was Built *
Do you own or rent your home? *
What type of pipes are present in your home? (Mark ALL that apply) *
Required

What type of solder is present in your home? (Mark ALL that apply)

*
Required

Do you have any additional items that connect directly to the tap being sampled? (Mark ALL that apply)

*
Required

I understand that this testing is being provided free of charge and all results will become public record.

*
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of City of Columbia, MO.

Does this form look suspicious? Report