WWW Technical Assistance Request Please enable JavaScript in your browser to complete this form.Name of Facility *AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePopulation Served *Primary Point of Contact *FirstLastPrimary Contact's Email *Primary Contact's Work Phone *Primary Contact's Cell Phone *Secondary Point of Contact *FirstLastSecondary Point of Contact Email *Secondary Contact's Work Phone(if different than above)Secondary Contact's Cell Phone(if different than above)Physical or Facility AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeType of Technical Assistance Needed (Select all that apply) WaterWells/GroundwaterDistributionSurface WaterLaboratoryRegulatoryPrepare for TCEQ InspectionOperationalEmergencyOtherWater OtherWastewaterTreatmentCollectionLaboratoryReporting – RegulationsPrepare for TCEQ InspectionIndustrial PretreatmentEmergencyOtherWastewater OtherUrgency *LowMediumHighCommentsSubmit
