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 $500 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. (And hard-copy if option is selected as "Yes" on this form.)

I also understand that by selecting "Yes" for the analysis data to be used for aggregation, People Over Pipelines simply intends to be permitted to include my test results in a baseline profile; no one's personal results will be identified; and none of the data will be passed or sold to any other entity for any reason whatever.

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

 

Precision Analytical Services, Inc.

is the new lab selected to do 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, and a copy will also be delivered to Responsible-Pipeline (for statistical purposes).

All inputs requested below are REQUIRED!

Precision Analytical Services, inc.