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Well Water Bacteria Test

  1. Collector/Sample Information (results are returned to this address)
  2. Include Area Code
  3. Owner Information (if different from collector information)
  4. Is the owner contact information different from the above?*
  5. Include Area Code

  6. Additional Information
  7. Bacteria Test Types
    There is a $13 fee for the bacteria test.
  8. Location
  9. Supply Type*
  10. Sewage Disposal*
  11. Construction Type*
  12. Leave This Blank: