Skip to Main Content
How Do I...
Select a Category
Hutchins Street Square
Report A Concern
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Cross Connection Control Survey
This form has been modified since it was saved. Please review all fields before submitting.
If you need help completing this form, please contact Brian Longpre at firstname.lastname@example.org or (209) 642-0749
List of potential hazards on site
Autopsy or Prep. Equipment
Food/ Dairy/ Meat processing
Heating & Cooling system (using water)
Minor medical facility
Major medical facility
Metal processing or plating
Multiple Looped Services
Multi-storied building (3+ stories)
Petroleum/ Chemical Processing
Photo development equipment
Pool, Pond, or Fountain
Recirculating/ Solar system
Sewage ejector/ pump
Well or auxiliary supply
None of the above
If you have a device installed, please complete the information below.
Type of device
Model name/ number
Name of person completing form
Additional Comments or Information
The City of Lodi thanks you for your participation in this survey
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
Submit and Print
* indicates a required field
Coronavirus COVID-19 information
Slideshow Left Arrow
Slideshow Right Arrow