Cross Connection Survey


Cross-Connection Control Survey

 This form MUST be completed and returned by July 1, 2022


All water suppliers are required by law to conduct a cross-connection control survey at least every two years. The last survey by Clark-Edgar Rural Water District was in 2020. Therefore, it is imperative that all customers again complete and return to us the following information.


If you desire the form may be completed online by clicking HERE!

Otherwise, you may print and fill in the following form: