[EDITORIAL NOTE]{.underline}: In question D4, the subjects who used
private wells for drinking were asked to provide a sample of their water
in order to measure the nitrate concentration. If interested, you can
obtain a copy of the household-well test request form from Mary Ward.

**NEBRASKA HEALTH STUDY II**

**SECTION D. RESIDENTIAL AND WATER SUPPLY HISTORY**

[INTRO]{.underline}: Now I\'d like to ask you about all the places where
(you/your \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_) lived for [at least 6
months]{.underline} before 1985.

+------------------------------+-------------------+-------------------+
| D1a. Where did (you/your     | D2. (Is/Was) this | D3. What years    |
| \_\_\_\_\_\_\_) live in      | a farm? (IF A     | did (you/he/she)  |
| 1985? Please give me the     | FARM, ASK: what   | live there? (D1b) |
| exact address, the city or   | was the           | (OBTAIN           |
| county, and state. (ENTER    | approximate       | [ALL]{.underline} |
| RESPONSE IN 01 BELOW). (D2)  | distance and      | RESIDENCES SINCE  |
|                              | direction from    | CHILDHOOD, THEN   |
| D1b. Before (PREVIOUS        | (CITY/ TOWN)? AND | ASK D4)           |
| ADDRESS/CITY), where did     | RECORD IN D1)     |                   |
| (you/he/she) live? Please    |                   |                   |
| give me the city or county   |                   |                   |
| and state. (ENTER RESPONSES  |                   |                   |
| IN 02-11 BELOW). (D2)        |                   |                   |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 01\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 02\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 03\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 04\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 05\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 06\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+

+------------------------------+-------------------+-------------------+
| D1b. Before (PREVIOUS        | D2. (Is/Was) this | D3. What years    |
| ADDRESS/CITY), where did     | a farm? (IF A     | did (you/he/she)  |
| (you/he/she) live? Please    | FARM, ASK: what   | live there? (D1b) |
| give me the city or county   | was the           | (OBTAIN           |
| and state. (ENTER RESPONSES  | approximate       | [ALL]{.underline} |
| IN 02-11 BELOW). (D2)        | distance and      | RESIDENCES SINCE  |
|                              | direction from    | CHILDHOOD THEN    |
|                              | (CITY/ TOWN)? AND | ASK D4)           |
|                              | RECORD IN D1)     |                   |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 07\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 08\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 09\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 10\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 11\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+
| EXACT ADDRESS                | FARM              | FROM:             |
|                              | ...........       | 19\_\             |
| 12\_\_\_\_\_\_               | ................. | _\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 1                 |                   |
| \_\_\_\_\_\_\_\_\_\_         |                   | YEAR              |
|                              | NON-FARM          |                   |
| NEAREST CITY/COUNTY STATE    | .....             | DK                |
|                              | ................2 | .                 |
| \_\_\_\_\_                   |                   | ................. |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ | DK                | ................. |
| \_\_\_\_\_\_\_\_\_\_\_       | ................. | 98                |
|                              | .............\... |                   |
| DISTANCE DIRECTION           | 8                 | TO: PRESENT       |
|                              |                   | .............. 95 |
|                              |                   |                   |
|                              |                   | OR                |
|                              |                   | 19\_\             |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | YEAR              |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ....              |
|                              |                   | ................. |
|                              |                   | ...............98 |
+------------------------------+-------------------+-------------------+

**AT THE END OF RESIDENTIAL HISTORY, ASK D4-D5 FOR EACH RESIDENCE.**

+------------------------------+-------------------+-------------------+
| D4. What (is/was) the        | D5. How deep      | D5a. What         |
| primary source of drinking   | (is/was) the      | (is/was) the      |
| water where (you/he/she)     | well?             | township, range,  |
| live(d) in ADDRESS/ CITY)?   |                   | and section       |
| (Is/Was) it . . .            |                   | number of the     |
|                              |                   | well?             |
| Com- House-                  |                   |                   |
|                              |                   |                   |
| munity hold Or other?        |                   |                   |
|                              |                   |                   |
| supply well Bottled specify  |                   |                   |
| DK                           |                   |                   |
|                              |                   |                   |
| (D4) (D5) (D4) (D4) (D4)     |                   |                   |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+

+------------------------------+-------------------+-------------------+
| D4. What (is/was) the        | D5. How deep      | D5a. What         |
| primary source of drinking   | (is/was) the      | (is/was) the      |
| water where (you/he/she)     | well?             | township, range,  |
| live(d) in ADDRESS/ CITY)?   |                   | and section       |
| (Is/Was) it . . .            |                   | number of the     |
|                              |                   | well?             |
| Com- House-                  |                   |                   |
|                              |                   |                   |
| munity hold Or other?        |                   |                   |
|                              |                   |                   |
| supply well Bottled specify  |                   |                   |
| DK                           |                   |                   |
|                              |                   |                   |
| (D4) (D5) (D4) (D4) (D4)     |                   |                   |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+
| 1 2 3 4 \_\_\_\_\_\_\_ 5     | \_                | TOWNSHIP:         |
|                              | \_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\     |
|                              | _\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_ |
|                              | FT                |                   |
|                              |                   | DK                |
|                              | \_\_\_\_\_\_\_\_\ | ...............   |
|                              | _\_\_\_\_\_\_\_\_ | 998               |
|                              | YDS               |                   |
|                              |                   | RANGE:            |
|                              | DK                | \_\_              |
|                              | .........         | \_\_\_\_\_\_\_\_\ |
|                              | ................. | _\_\_\_\_\_\_\_\_ |
|                              | 998               |                   |
|                              |                   | DK                |
|                              |                   | ............\...  |
|                              |                   | 998               |
|                              |                   |                   |
|                              |                   | SECTION:          |
|                              |                   | \_\_\_\_\_\_\_\_\ |
|                              |                   | _\_\_\_\_\_\_\_\_ |
|                              |                   |                   |
|                              |                   | DK                |
|                              |                   | ...............   |
|                              |                   | 998               |
+------------------------------+-------------------+-------------------+

**AT THE END OF WATER SUPPLY HISTORY, GO TO D6.**

D6. (Have you/Did your \_\_\_\_\_\_\_\_\_\_) ever live(d) in a house
without a refrigerator, including when (you/he/she) (were/was) a child?
(AN ICEBOX IS [NOT]{.underline} A REFRIGERATOR.)

YES 1

NO 2 (D8)

DK 8 (D8)

D7. What was the year or how old (were you/was your
\_\_\_\_\_\_\_\_\_\_) when there first was a refrigerator in the house?

AGE: \|\_\_\_\|\_\_\_\| YEAR: \|\_\_\_\|\_\_\_\|

DK 98

D8. Before 1985, did (you/your \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_) ever have
a wood- or coal-burning stove or furnace in any of (your/his/her) homes?
If so, what kind was it? (THIS DOES NOT INCLUDE FIREPLACES.)

WOOD 1

COAL 2

WOOD/COAL 3

NEITHER 4

DK 8

D9. In total, how many years did (you/he/she) live in homes with a
(wood-/(or) coal-burning) stove or furnace?

\_\_\_\_\_\_\_\_\_\_\_\_ YEARS

FROM \|\_\_\|\_\_\|\_\_\|\_\_\| TO \|\_\_\|\_\_\|\_\_\|\_\_\|

Y Y Y Y Y Y Y Y

DK 98