New Customer Environmental Enrollment Form

Date Submitted & Year For Enrollment

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This request is for enrollment year: *

Identification Information

WSLH PT ID (7 Digits)
Wisconsin Department of Natural Resources ID#
Wisconsin Department of Agriculture, Trade and Consumer Protection ID#

Contact Information of person completing this form

Facility Name *
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Phone *Example: 123-456-7890
Email *

Shipping Information

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Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
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Email *

Billing Information

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Phone Example: 123-456-7890
Fax
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Send Reports To:

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Facility Name
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Address
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Phone Example: 123-456-7890
Fax
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Select Type Of Testing Site For This Order

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Other:

Order Form: Potable Water

Certification Samples
Quality Control Standards
SDWA Cyanide (Total Cyanide)
PT08160 $48.00
SDWA Cyanide (Total Cyanide)
PT08370 $144.00
SDWA Metals
(Antimony; Arsenic; Barium; Beryllium; Cadmium; Chromium; Copper; Lead; Mercury; Nickel; Selenium; Sodium; Thallium)PT08170 $66.00
SDWA Metals
(Antimony; Arsenic; Barium; Beryllium; Cadmium; Chromium; Copper; Lead; Mercury; Nickel; Selenium; Sodium; Thallium)PT08380 $198.00
SDWA Minerals
Nitrate as N; Nitrate + Nitrate as N; Fluoride; Sulfate)PT08180 $46.00
SDWA Minerals
Nitrate as N; Nitrate + Nitrate as N; Fluoride; Sulfate)PT08390 $138.00
SDWA Nitrate (Nitrate as N)
(Nitrate as N)PT08190 $44.00
SDWA Nitrate
(Nitrate as N)PT08400 $132.00

Order Form: Non-Potable Water

Certification Samples
Quality Control Standards
BOD/CBOD/COD
(Biological Oxygen Demand; CBOD; Chemical Oxygen Demand)PT08000 $50.00
BOD/CBOD/COD
(Biological Oxygen Demand; CBOD; Chemical Oxygen Demand)PT08200 $150.00
Chlorine
(Total residual chlorine)PT08010 $47.00
Chlorine
(Total residual chlorine)PT08210 $141.00
Cyanide
(Total Cyanide)PT08020 $48.00
Cyanide
(Total Cyanide)PT08220 $144.00
Hardness
(Hardness [EDTA])PT08030 $44.00
Hardness
(Hardness [EDTA])PT08240 $132.00
Metals A
(Aluminum; Barium; Cadmium; Calcium; Chromium; Cobalt; Copper; Hardness; Iron; Lead; Magnesium; Manganese; Nickel; Potassium; Silver; Sodium; Zinc)PT08040 $66.00
Metals A
(Aluminum; Barium; Cadmium; Calcium; Chromium; Cobalt; Copper; Hardness; Iron; Lead; Magnesium; Manganese; Nickel; Potassium; Silver; Sodium; Zinc)PT08250 $198.00
Metals B
(Arsenic; Mercury; Selenium)PT08050 $60.00
Metals B
(Arsenic; Mercury; Selenium)PT08260 $180.00
Metals C
(Antimony; Beryllium; Molybdenum; Strontium; Thallium; Vanadium)PT08060 $60.00
Metals C
(Antimony; Beryllium; Molybdenum; Strontium; Thallium; Vanadium)PT08270 $180.00
Metals D
(Bismuth; Lithium; Silicon; Titanium)PT08070 $66.00
Metals D
(Bismuth; Lithium; Silicon; Titanium)PT08280 $198.00
Metals E
(Boron; Tin)PT08080 $61.00
Metals E
(Boron; Tin)PT08290 $183.00
Minerals
(Alkalinity CaCO3; Chloride; Conductivity; Fluoride; Sulfate)PT08090 $50.00
Minerals
(Alkalinity CaCO3; Chloride; Conductivity; Fluoride; Sulfate)PT08300 $150.00
Nitrite
(Nitrite as N)PT08100 $44.00
Nitrite
(Nitrite as N)PT08310 $132.00
Nutrients A
(Ammonia as N; Nitrate as N; Nitrate + Nitrite as N; ortho‐Phosphate as P)PT08110 $50.00
Nutrients A
(Ammonia as N; Nitrate as N; Nitrate + Nitrite as N; ortho‐Phosphate as P)PT08320 $150.00
Nutrients B
(Total Kjeldahl nitrogen [TKN]; Total phosphorus)PT08120 $44.00
Nutrients B
(Total Kjeldahl nitrogen [TKN]; Total phosphorus)PT08330 $132.00
Oil and Grease
(HEM)PT08130 $63.00
Oil and Grease
(HEM)PT08340 $198.00
pH
PT08140 $42.00
pH
PT08350 $126.00
Solids
Total Dissolved Solids [TDS]; Total Suspended Solids)PT08150 $53.00
Solids
Total Dissolved Solids [TDS]; Total Suspended Solids)PT08360 $159.00

Order Form: Water Microbiology

Water Microbiology – Certification
PT08410 $296.00
Water Microbiology – Quality Assurance (Two events: March and October)
PT08420 $156.00
Water Microbiology – Quality Assurance (One event: March)
PT08430 $78.00
Water Microbiology – Quality Assurance (One event: October)
PT08440 $78.00

Order Form: Total Price

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New Customer Environmental Enrollment Form

Date Submitted & Year For Enrollment

Identification Information

Contact Information of person completing this form

Shipping Information

Billing Information

Send Reports To:

Select Type Of Testing Site For This Order

Order Form: Potable Water

Certification Samples

Quality Control Standards

Order Form: Non-Potable Water

Certification Samples

Quality Control Standards

Order Form: Water Microbiology

Order Form: Total Price

Indicate Method Of Payment

Verification