form

Date of Observation

MM

DD

YYYY

Time of Observation

Hour

Minute

Second

AM PM

Address or Location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Customer Present

Yes

No

Name of Person Present *

First Name

Last Name

Property Type

Residential

Apartment

Commercial

Irrigation

Type of Violation

check all that apply

Use of potable water to irrigate turf, lawn or garden outside of the current watering schedule.

Use of a hose without a shut-off nozzle to wash vehicles, structures, and/or hard-surfaced areas.

Visible signs of excessive water runoff and/or flooding from landscaping onto sidewalks, gutters, and driveways.

Broken, leaking or defective customer plumbing, sprinkler or irrigation system that requires repair.

Use of potable water in a fountain or water feature, except where the water is re-circulated.

Use of potable water for the filling or refilling of swimming pools, or visible signs of excessive pool pumping.

Corrective Action

Check all that apply

Verbal Warning to explain violation, educate customer and have them correct issue.

Hung “Water Waster Violation” tag on the door of premises where violation occurred.

Per request of customer, reset sprinkler timer to comply with Mandatory Watering Schedule.

Shut off sprinkler system for non-compliance with Watering Schedule.

Shut off water at curb-stop or house valve for excessive flooding from waste or plumbing malfunction.