If you are human, leave this field blank.New Customer Environmental Enrollment FormEnrollment Information Enrollment Information This request is for enrollment year: *Identification Information Identification Information WSLH PT ID (7 Digits)Current/previous account ID (if known)WI DNR ID#Wisconsin Department of Natural ResourcesWI DATCP ID#Wisconsin Department of Agriculture, Trade and Consumer ProtectionContact Information of person completing this form Contact Information of person completing this form Facility Name *Contact Name *Phone *Example: 123-456-7890Email *Type Of Testing Site For This Order Type Of Testing Site For This Order Select Type Commercial laboratoryDairy laboratoryHazardous waste laboratoryIndustrial laboratorySmall municipal WWTPLarge municipal WWTPLandfill laboratoryPublic health laboratoryPublic water supplyOther (Please specify at right)Indicate "Other" type of testing hereShipping Information Shipping Information Facility Name *Contact Name *AddressApt, suite, etc.CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codePhone *Example: 123-456-7890FaxEmail *Billing Information Billing Information Check here if same as shipping informationFacility nameContact nameAddressApt, suite, etc.CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codePhoneExample: 123-456-7890FaxEmailSend Reports To: Send Reports To: Check here if same as shipping information.Facility NameContact NameAddressApt, suite, etc.CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codePhoneExample: 123-456-7890FaxEmailOrder Form: Potable Water Order Form: Potable Water Certification Samples Quality Control Standards SDWA Cyanide - CertItem#:PT08160 - Price: $48.00(Total Cyanide)SDWA Cyanide - QCItem#:PT08370 - Price: $144.00(Total Cyanide) SDWA Metals - CertItem#: PT08170 - Price: $66.00(Antimony; Arsenic; Barium; Beryllium; Cadmium; Chromium; Copper; Lead; Mercury; Nickel; Selenium; Sodium; Thallium)SDWA Metals - QCItem#: PT08380 - Price: $198.00(Antimony; Arsenic; Barium; Beryllium; Cadmium; Chromium; Copper; Lead; Mercury; Nickel; Selenium; Sodium; Thallium) SDWA Minerals - CertItem#: PT08180 - Price: $46.00(Nitrate as N; Nitrate + Nitrate as N; Fluoride; Sulfate)SDWA Minerals - QCItem#: PT08390 - Price: $138.00(Nitrate as N; Nitrate + Nitrate as N; Fluoride; Sulfate) SDWA Nitrate - CertItem#: PT08190 - Price: $44.00(Nitrate as N)SDWA Nitrate - QCItem#: PT08400 - Price: $132.00(Nitrate as N)Order Form: Non-Potable Water Order Form: Non-Potable Water Certification Samples Quality Control Standards BOD/CBOD/COD - CertItem#: PT08000 - Price: $50.00(Biological Oxygen Demand; CBOD; Chemical Oxygen Demand)BOD/CBOD/COD - QCItem#: PT08200 - Price: $150.00(Biological Oxygen Demand; CBOD; Chemical Oxygen Demand) Chlorine - CertItem#: PT08010 - Price: $47.00(Total residual chlorine)Chlorine - QCItem#: PT08210 - Price: $141.00(Total residual chlorine) Cyanide - CertItem#: PT08020 - Price: $48.00(Total Cyanide)Cyanide - QCItem#: PT08220 - Price: $144.00(Total Cyanide) Hardness - CertItem#: PT08030 - Price: $44.00(Hardness [EDTA])Hardness - QCItem#: PT08240 - Price: $132.00(Hardness [EDTA]) Metals A - CertItem#: PT08040 - Price: $66.00(Aluminum; Barium; Cadmium; Calcium; Chromium; Cobalt; Copper; Hardness; Iron; Lead; Magnesium; Manganese; Nickel; Potassium; Silver; Sodium; Zinc)Metals A - QCItem#: PT08250 - Price: $198.00(Aluminum; Barium; Cadmium; Calcium; Chromium; Cobalt; Copper; Hardness; Iron; Lead; Magnesium; Manganese; Nickel; Potassium; Silver; Sodium; Zinc) Metals B - CertItem#: PT08050 - Price: $60.00(Arsenic; Mercury; Selenium)Metals B - QCItem#: PT08260 - Price: $180.00(Arsenic; Mercury; Selenium) Metals C - CertItem#: PT08060 - Price: $60.00(Antimony; Beryllium; Molybdenum; Strontium; Thallium; Vanadium)Metals C-QCItem#: PT08270 - Price: $180.00(Antimony; Beryllium; Molybdenum; Strontium; Thallium; Vanadium) Metals D - CertItem#: PT08070 - Price: $66.00(Bismuth; Lithium; Silicon; Titanium)Metals D - QCItem#: PT08280 - Price: $198.00(Bismuth; Lithium; Silicon; Titanium) Metals E - CertItem#: PT08080 - Price: $61.00(Boron; Tin)Metals E - QCItem#: PT08290 - Price: $183.00(Boron; Tin) Minerals - CertItem#: PT08090 - Price: $50.00(Alkalinity CaCO3; Chloride; Conductivity; Fluoride; Sulfate)Minerals - QCItem#: PT08300 - Price: $150.00(Alkalinity CaCO3; Chloride; Conductivity; Fluoride; Sulfate) Nitrite - CertItem#: PT08100 - Price: $44.00(Nitrite as N)Nitrite - QCItem#: PT08310 - Price: $132.00(Nitrite as N) Nutrients A - CertItem#: PT08110 - Price: $50.00(Ammonia as N; Nitrate as N; Nitrate + Nitrite as N; ortho‐Phosphate as P)Nutrients A - QCItem#: PT08320 - Price: $150.00(Ammonia as N; Nitrate as N; Nitrate + Nitrite as N; ortho‐Phosphate as P) Nutrients B - CertItem#: PT08120 - Price: $44.00(Total Kjeldahl nitrogen [TKN]; Total phosphorus)Nutrients B - QCItem#: PT08330 - Price: $132.00(Total Kjeldahl nitrogen [TKN]; Total phosphorus) Oil and Grease - CertItem#: PT08130 - Price: $63.00(HEM)Oil and Grease - QCItem#: PT08340 - Price: $198.00(HEM) pH - CertItem#: PT08140 - Price: $42.00(pH)pH - QCItem#: PT08350 - Price: $126.00(pH) Solids -CertItem#: PT08150 - Price: $53.00Total Dissolved Solids [TDS]; Total Suspended Solids)Solids - QCItem#: PT08360 - Price: $159.00Total Dissolved Solids [TDS]; Total Suspended Solids)Order Form: Water Microbiology Order Form: Water Microbiology Water Microbiology – CertificationItem#: PT08460 - Price: $296.00 Water Microbiology – Quality Assurance (Two events: March and October)Item#: PT08420 - Price: $156.00 Water Microbiology – Quality Assurance (One event: March)Item#: PT08430 - Price: $78.00 Water Microbiology – Quality Assurance (One event: October)Item#: PT08440 - Price: $78.00Other Environmental Samples Other Environmental Samples Survey Validated Samples and Rapid Response PTCustomers wanting to order Survey Validated Samples or Rapid Response PT please provide order information from WSLH PT coordinator in the field below.Order Total Order Total Order TotalAdd price of all checked itemsPayment Information Payment Information Purchase Order (PO#) - optionalVISA/MC: If you wish to pay by credit card, please wait for your invoice for instructions. Verification *reCAPTCHA is required.This step is to verify this form is being completed by a person and not a computer.Submit Contact WSLH Proficiency Testing | (800) 462-5261 | ptservice@slh.wisc.edu |