Form Center

2. Lead and Copper Rule Revision Self-Report Form

   Follow these steps to identify your the material of your service line. To complete this form, you will need to gather a coin or key, and a magnet. 

   1.  Find where your service line enters your home. This will most likely be located in your crawl space, utility closet, or basement. 

   2.  Check the pipe material. Using a coin or key, gently scratch the pipe to reveal its color. Use a magnet to see if it sticks to be pipe. 

   If the pipe is:

   • Red, blue, black, or white it is plastic.
   • The color of a penny or greenish, and not magnetic, it is copper. 
   • Dark yellow or golden, it is brass.
   • Dull gray and magnetic, it is galvanized steel.
   • Shiny gray, not magnetic, and scrapes easily, it is lead. 

   Take a picture of your results.

4. Last Name
5. First Name
7. Service Address
9. Account Number
10. Do you own or rent?

    1. Own
    2. Rent
12. Service Line Material

    1. Plastic
    2. Copper
    3. Brass
    4. Galvanized Steel
    5. Lead
    6. Not sure
13. Picture of Results

15. For questions or concerns, please contact Rachel Tripp at 804-657-2034 or rtripp@goochlandva.us.

Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field