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2. Water/Sewer Problems Reporting Form
4. Note:
   Use this form to contact staff between the hours of 7 am and 3 pm, Monday through Friday. After business hours, emergencies can be reported to the Anoka-Champlin Fire Department dispatch at 763-576-2860.
6. Date*
   Date
7. Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Email Address
16. Phone Number
18. Approximate Time of Water Outage*
20. Comments
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field