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2. The Department of Water and Wastewater Resources offers FREE water-saving devices for residents.

   Complete the form below or call (650) 991-8200 to order yours today. 
   All items will be delivered to your Daly City address.

4. First Name*

   First Name

5. Last Name*

   Last Name

7. Address*

   Street Address

9. City*
   -- Select One --Daly City
10. State*
    -- Select One --CA
11. Zip Code*
    -- Select One --9401494015
13. Phone Number

    Phone Number

14. Email Address

    Email Address

16. Please indicate which conservation products you are requesting by checking the appropriate box(es) below:
18. Indoor Devices

    1. 5-Minute Shower Timer (Blue)
    2. Bathroom Aerator
    3. Leak Detection Tablet (2 pack)
    4. Wall Mount Shower Head
19. Outdoor Devices

    1. Frog Moisture Meter
    2. Hose Nozzle 7-Pattern
    3. Lady Bug Moisture Meter
21. Comments / Questions:

    If you are requesting more than 1 of a specific item, please make that notation here.

22. Deliver Instructions / Notes:

    Ex: ring doorbell, leave at gate, leave on porch, or leave by mailbox, etc.

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field