Date Site Lead Tier Added Location Physical Address (CWS) or Year Plumbing Materials in Service 1, 2, 3 Justification for designation of Comments Explaining (A) / Code Physical Location (NTNC) Built Structure Line (LSL)? or Tier 1, Tier 2, Tier 3 or Other Change Deleted Yes / No Other (D)
Location Code Physical Address (CWS) or Physical Location (NTNC) Year Built Plumbing Materials in Structure Lead Service Line (LSL)? Yes / No Tier 1, 2, 3 or Other Justification for designation of Tier 1, Tier 2, Tier 3 or Other Date Site Added (A) / Deleted (D) Comments Explaining Change
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