Responsible Pipeline

 

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Well Water Test Order Form

Full Name:  
Street Address:  
City, State ZIP:  
Phone Number (xxx-xxx-xxxx):  
Email Address:  
Hard copy sent by US Mail?  
Use analysis data for aggregation?  

I wish to participate in the People Over Pipelines Well Water Testing.

I understand the cost is $375 per household, cash or check payment due upon the water sample collection.

I also understand that I will receive my test results via email in a PDF format. (Or hard-copy if option is selected as "Yes" on this form.)

http://www.ccdcgreenway.org/images/Water%20Well%20Color

Envirotek Laboratories, Inc.

Bordentown, NJ

was the lab selected to do any well tests along the GSE and SRL route.

When you click the Send Test Order button at the bottom of the form, the  information that you provided will be sent DIRECTLY to the lab, the collection agent, and a copy will also be delivered to Responsible-Pipeline (for statistical purposes).

All inputs requested below are REQUIRED!