Name * E-mail Address: * Address How well educated are you concerning recent stormwater regulations? Not educated Somewhat educated Highly Educated Would you like to learn more about the current stormwater regulations that the city is required to comply with? Yes No Maybe Do you think that the streams in our area are cleaner than they were in the past (10 years ago)? Yes No Havent noticed a change Which of the following pollutant sources do you feel have an impact on water quality in our city? Sewers discharges Leaking septic tanks Erosion Runoff from paved areas Pesticides & Other fertilizers Oils, greases, antifreeze, etc... Pet/ animal waste Litter along roads Yard waste Household detergents Runoff from construction sties Other Which of the following activities do you typically do that could help improve water quality? Recycle packaging and paper Use a mulching mower Compost grass, leaves, & waste... Water the yard only when needed Properly dispose of used motor oil Properly dispose of paint & chemicals Using appropriate containers for garbage Follow directions when applying fertilizers Wash the car at the car wash Pick up after pets Clean up leaves Other When purchasing household items do you consider the following? Recycle packaging Biodegradable ingredients Would you consider adapting some of your daily activities to improve water quality if provided the information or items to do so? Yes No Possibly Would you be willing to get involved in a committee to assist in developing a stormwater plan? Yes No Add any last minute comments in the box below: