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Well Water Chemical 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. Chemical Test Types
    Select 1 or more chemical test types. There is an $8 fee for each chemical test.
  8. Nitrates
  9. Sulfates
  10. Chlorine
  11. Iron
  12. Hardness
  13. Location
  14. Supply Type*
  15. Sewage Disposal*
  16. Construction Type*
  17. Leave This Blank: