PNWS-AWWA P.O. Box 2050 Clackamus, OR 97015-2050 (877) 767-2992

PUBLICATION ORDER FORM CROSS CONNECTION MATERIALS from PNWS/AWWA

	QUANTITY	PRICE	TOTAL
CROSS-CONNECTION CONTROL MANUAL, ACCEPTED PROCEDURE AND PRACTICE:       8 1/2" x 11" in 3-ring binder	________	$25.00 ea	________
$20.00 ea. for case of 50	________ cs	$1000.00/cs	________
5" x 7" in spiral binder	________	$25.00 ea	________
$20.00 ea. for case of 50	________ cs	$1000.00/cs	________
CROSS-CONNECTION CONTROL MANUAL, SUPPLEMENT No.1, SAMPLE LETTERS AND RECORD FORMS	________	$20.00 ea	________
CROSS-CONNECTION CONTROL MANUAL, SUPPLEMENT No.2, SAMPLE ORDINANCES AND RESOLUTIONS	________	$20.00 ea	________
SUMMARY OF BACKFLOW INCIDENTS	________	$20.00 ea	________
BACKFLOW INCIDENT INVESTIGATION PROCEDURES	________	$20.00 ea	________
CD-ROM Edition: All of the above five manuals in PDF format with Adobe Acrobat Reader included	________	$25.00 ea	________

BROCHURES:	For each brochure:
"Lawn Irrigation"	______ lot of   200 for   $40.00	________
"Residential Fire Sprinkler Systems"	______ lot of   500 for   $90.00	________
"Cross-Connection Create Health Hazards"	______ lot of 1000 for $150.00	________

Make checks payable to PNWS-AWWA

TOTAL ORDER       $ ______________

COMPANY NAME: _______________________________________________________________ (please print)

MAILING ADDRESS ____________________________________________________________

CITY _____________________________ STATE __________________ ZIP ________________

Telephone: (______)_________________________________

            REVISED 12/2000