Date Leak Discovered
Date Leak Repaired
Under penalty of law, I certify that the information above is true and correct.
I certify that the above described leak has been repaired by:
Upload Receipt(s) for Leak Repair
Please review the Water & Sewer Adjustment Policy. http://www.cityofgastonia.com/images/files/finance/documents/customer_service/documents/ws-customer-adjustment-policy-rev-12-2012.pdf
I have read a copy of the Water & Sewer Adjustment Policy.