Background Information

Q1.1	Individual's Name:

Q1.2	Who do you represent?

Q1.3	What is you title?

Q1.4	What is your mailing address?

Q1.5	What is your telephone number?

Q1.6	What is your E-mail address?

Q1.7	Do you have a website?
		Yes		No

Q1.8	If so, what is it's address:

Regional

Q1.9	Have you read the Birmingham Regional Water Resource Assessment of September, 2004?
		Yes		No

Q1.10	In your opinion does the region have sufficient capability to meet commercial and residential water demands for the next 20 years?
		Yes		No		No opinion

Q1.11	Does your water system service populations outside of your jurisdiction?
		Yes		No		Not Sure

Q1.12	Does your water system purchase water from another system on a regular basis (defined as being more than 60-days per year)?
		Yes		No		Not Sure

Q1.13	Doe your wat6er system purchase water from another system on an as needed basis (i.e. less than 60-days per year)?
		Yes		No		Not Sure

Q1.14	Does your system have infrastructure to (Select all that apply):
		Treat water		Store water		Store and use rain water		Transfer finished water

Q1.15	Do you feel that local interbasin transfers would benefit your water system?
		Yes		No		Not Sure

Q1.16	Do you feel that interstate interbasin transfers would benefit your water system?
		Yes		No		Not Sure

Q1.17	Do Alabama Power company's requirements affect your systems water availability?
		Yes		No		No Opinion

Q1.18	Please select the county in which you are located (water system
		--Click Here--Blount CountyChilton CountyJefferson CountyShelby CountySt. Clair CountyWalker County

Blount County

Q2.1	Do you agree that a high growth rate is anticipated for Blount County?
		Yes		No		Not Sure

Q2.2	Does your water system have difficulty with adequate drinking water production?
		Yes		No		Not Sure

Q2.3	If so, what are the causes of the difficulty?

Q2.4	Please provide the risk(s) of contamination to your water source as defined in your Source Water Assessment Plan.

Q2.5	Does your water system have a written back-up water supply plan with other utilities?
		Yes		No		Not Sure

Q2.6	If yes, which ones?

Q2.7	Do you have a written long-range plan for your water system?
		Yes		No		Not Sure

Q2.8	Do you have a written energy plan?
		Yes		No		Not Sure

Q2.9	Do all of your communities have a current Wellhead Protection Program on file with ADEM?
		Yes		No		Not Sure

Q2.10	Do you have an emergency drought plan?
		Yes		No		Not Sure

Chilton County

Q3.1	Do you agree that a high growth rate is anticipated for Chilton County?
		Yes		No		Not Sure

Q3.2	Does your water system have difficulty with adequate drinking water production?
		Yes		No		Not Sure

Q3.3	Please rate the risk of contamination to your water source:
		High		Medium		Low