State Staff Emergency Response Assessment – Ice Strom Feb 2021

Date of Survey/Update *

Type of Assessment *

Staff Submitting Survey *

System Name *

LRWA Account Number *

Is normal (electrical company) power currently available at system? *

If no, how long, in days, do you anticipate until normal power supply will be restored?

Days

Is backup power currently available? *

Backup power source?

What is current system status? *

Check all that apply.

Provide an estimate of percentage of customers that are currently OUT of water service.

Estimated percentage.

System needs relating to current Winter Storm (pumps, generator(s), pipe, etc)?

Estimated costs of needs from previous question (Use full $ amounts, no comma or decimal).

Cost in $.

At this time, do you feel it is likely that the system will require Federal funding assistance related to this Winter Storm disaster?

Check all that apply