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Idaho New Mailer

M5 - Water Sample Date

Water Source

Well Water
City Water
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Do You Buy Bottled Water?

Yes
No
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Do You Experience...

Chlorine Smell
Brown Stains
Scale Deposits
Rotten Smell
Cloudiness
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How Would You Rate Your Water?

Good
Fair
Poor
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Are You Using Filters?

Refrigerator
Whole Home
Sink
None
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