| 
		                                        What is your request (Please select one)
		                                     | 
 
|   | 
		                                        Turn off water
		                                     | 
 
| 
		                                        Turn Off Water – Meter Reading (Optional)
		                                     | 
 
|   | 
		                                        5,818.32
		                                     | 
 
| 
		                                        Turn Off Water: Date for requested action (Required)
		                                     | 
 
|   | 
		                                        04/21/2022
		                                     | 
 
| 
		                                        Lateral Selection
		                                     | 
 
|   | 
		                                        53AA
		                                     | 
 
| 
		                                        Turnouts for Lateral 53AA
		                                     | 
 
|   | 
		                                        4AH
		                                     | 
 
| Contact information | 
 
| 
		                                        Name
		                                     | 
 
|   | 
		                                        Mark Meyer
		                                     | 
 
| 
		                                        Email
		                                     | 
 
|   | 
		                                        ag_guy@live.com
		                                     | 
 
| 
		                                        Phone #
		                                     | 
 
|   | 
		                                        (303) 489-1196
		                                     | 
 
 
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