New Customer Environmental Enrollment Form

Enrollment 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 Resources

WI DATCP ID#

Wisconsin Department of Agriculture, Trade and Consumer Protection

Contact Information of person completing this form

Contact Information of person completing this form

Facility Name *

Contact Name *

Phone *

Example: 123-456-7890

Email *

Type Of Testing Site For This Order

Type Of Testing Site For This Order

Select Type

Indicate "Other" type of testing here

Shipping Information

Shipping Information

Facility Name *

Contact Name *

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone *

Example: 123-456-7890

Fax

Email *

Billing Information

Billing Information

Check here if same as shipping information

Facility name

Contact name

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone

Example: 123-456-7890

Fax

Send Reports To:

Send Reports To:

Check here if same as shipping information.

Facility Name

Contact Name

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone

Example: 123-456-7890

Fax

Order Form: Potable Water

Order Form: Potable Water

Certification Samples

Quality Control Standards

SDWA Cyanide - Cert

Item#:PT08160 - Price: $48.00

(Total Cyanide)

SDWA Cyanide - QC

Item#:PT08370 - Price: $144.00

(Total Cyanide)

SDWA Metals - Cert

Item#: PT08170 - Price: $66.00

(Antimony; Arsenic; Barium; Beryllium; Cadmium; Chromium; Copper; Lead; Mercury; Nickel; Selenium; Sodium; Thallium)

SDWA Metals - QC

Item#: PT08380 - Price: $198.00

(Antimony; Arsenic; Barium; Beryllium; Cadmium; Chromium; Copper; Lead; Mercury; Nickel; Selenium; Sodium; Thallium)

SDWA Minerals - Cert

Item#: PT08180 - Price: $46.00

(Nitrate as N; Nitrate + Nitrate as N; Fluoride; Sulfate)

SDWA Minerals - QC

Item#: PT08390 - Price: $138.00

(Nitrate as N; Nitrate + Nitrate as N; Fluoride; Sulfate)

SDWA Nitrate - Cert

Item#: PT08190 - Price: $44.00

(Nitrate as N)

SDWA Nitrate - QC

Item#: 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 - Cert

Item#: PT08000 - Price: $50.00

(Biological Oxygen Demand; CBOD; Chemical Oxygen Demand)

BOD/CBOD/COD - QC

Item#: PT08200 - Price: $150.00

(Biological Oxygen Demand; CBOD; Chemical Oxygen Demand)

Chlorine - Cert

Item#: PT08010 - Price: $47.00

(Total residual chlorine)

Chlorine - QC

Item#: PT08210 - Price: $141.00

(Total residual chlorine)

Cyanide - Cert

Item#: PT08020 - Price: $48.00

(Total Cyanide)

Cyanide - QC

Item#: PT08220 - Price: $144.00

(Total Cyanide)

Hardness - Cert

Item#: PT08030 - Price: $44.00

(Hardness [EDTA])

Hardness - QC

Item#: PT08240 - Price: $132.00

(Hardness [EDTA])

Metals A - Cert

Item#: PT08040 - Price: $66.00

(Aluminum; Barium; Cadmium; Calcium; Chromium; Cobalt; Copper; Hardness; Iron; Lead; Magnesium; Manganese; Nickel; Potassium; Silver; Sodium; Zinc)

Metals A - QC

Item#: PT08250 - Price: $198.00

(Aluminum; Barium; Cadmium; Calcium; Chromium; Cobalt; Copper; Hardness; Iron; Lead; Magnesium; Manganese; Nickel; Potassium; Silver; Sodium; Zinc)

Metals B - Cert

Item#: PT08050 - Price: $60.00

(Arsenic; Mercury; Selenium)

Metals B - QC

Item#: PT08260 - Price: $180.00

(Arsenic; Mercury; Selenium)

Metals C - Cert

Item#: PT08060 - Price: $60.00

(Antimony; Beryllium; Molybdenum; Strontium; Thallium; Vanadium)

Metals C-QC

Item#: PT08270 - Price: $180.00

(Antimony; Beryllium; Molybdenum; Strontium; Thallium; Vanadium)

Metals D - Cert

Item#: PT08070 - Price: $66.00

(Bismuth; Lithium; Silicon; Titanium)

Metals D - QC

Item#: PT08280 - Price: $198.00

(Bismuth; Lithium; Silicon; Titanium)

Metals E - Cert

Item#: PT08080 - Price: $61.00

(Boron; Tin)

Metals E - QC

Item#: PT08290 - Price: $183.00

(Boron; Tin)

Minerals - Cert

Item#: PT08090 - Price: $50.00

(Alkalinity CaCO3; Chloride; Conductivity; Fluoride; Sulfate)

Minerals - QC

Item#: PT08300 - Price: $150.00

(Alkalinity CaCO3; Chloride; Conductivity; Fluoride; Sulfate)

Nitrite - Cert

Item#: PT08100 - Price: $44.00

(Nitrite as N)

Nitrite - QC

Item#: PT08310 - Price: $132.00

(Nitrite as N)

Nutrients A - Cert

Item#: PT08110 - Price: $50.00

(Ammonia as N; Nitrate as N; Nitrate + Nitrite as N; ortho‐Phosphate as P)

Nutrients A - QC

Item#: PT08320 - Price: $150.00

(Ammonia as N; Nitrate as N; Nitrate + Nitrite as N; ortho‐Phosphate as P)

Nutrients B - Cert

Item#: PT08120 - Price: $44.00

(Total Kjeldahl nitrogen [TKN]; Total phosphorus)

Nutrients B - QC

Item#: PT08330 - Price: $132.00

(Total Kjeldahl nitrogen [TKN]; Total phosphorus)

Oil and Grease - Cert

Item#: PT08130 - Price: $63.00

(HEM)

Oil and Grease - QC

Item#: PT08340 - Price: $198.00

(HEM)

pH - Cert

Item#: PT08140 - Price: $42.00

(pH)

pH - QC

Item#: PT08350 - Price: $126.00

(pH)

Solids -Cert

Item#: PT08150 - Price: $53.00

Total Dissolved Solids [TDS]; Total Suspended Solids)

Solids - QC

Item#: PT08360 - Price: $159.00

Total Dissolved Solids [TDS]; Total Suspended Solids)

Order Form: Water Microbiology

Order Form: Water Microbiology

Water Microbiology – Certification

Item#: PT08410 - 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: $78.00

Order Total

Order Total

Order Total

Add price of all checked items

Payment Information

Payment Information

Purchase Order (PO#) - optional

VISA/MC: If you wish to pay by credit card, please wait for your invoice for instructions.

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