Your browser either does not support JavaScript or you have JavaScript disabled. Please enable JavaScript or view this page in
Text Version
.
Skip Navigation
This table is used for column layout.
Accomodations
Calendar of Events
Community Profile
Contacts
Library
Links
Parking
Parks
Restaurants
Salem Fire Protection District
Salem Township Hospital
Schools
Streets & Points of Interest Map
Mayor
City Council
City Manager
City Clerk
City Treasurer
City Attorney
Finance
Planning Commission
Zoning Board of Appeals
Utilities
Boards and Commissions
Water
Sewer
Gas
Garbage / Refuse Collection
Landscape Waste Collection
Leaf Collection
Salem Pool
Museum
Site
This Folder
Advanced Search
Cross-Connection Control Survey (Commercial 2/2)
Printer-Friendly Version
Please indicate the type of business conducted on this premises; then please indicate any of the following that are present on the property.
Choose from the following:
Checkboxes
Checkbox Description
Checkboxes
Checkbox Description
Retail
Agricultural
Medical
Government
Industrial
Other ...
----------------------------------------------------
----------------------------------------------------
Drinking fountains
Embalming facilities (mortuaries)
Fountain drinks
Car wash facilities
Fire protection system
Baptismal fount / tub
Watering troughs
Photo processing equipmenet
Bulk water salesman
Shampoo bowl / sink
Mixing tanks (with overhead fill lines)
Petroleum processing
Mixing tanks (with botton fill lines)
Please provide the following information:
Field Description
Field Data
Required Field
Name/Title Of Person Completing The Form:
required
Email:
required
Address Of Property Being Surveyed:
required
Do you have another source of water on the property, such as a well, lake, or cistern?
Field Data
No
Yes
Is this source connected to the public water system?
Field Data
No
Yes
If "Other" type of business was selected above, please indicate the type of business here:
List any other water-related fixtures on these premises:
